Provider Demographics
NPI:1992470439
Name:SCHULLER, NICHOLAS PAUL
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PAUL
Last Name:SCHULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15335 HOLBEIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2517
Mailing Address - Country:US
Mailing Address - Phone:402-314-2835
Mailing Address - Fax:
Practice Address - Street 1:4908 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2913
Practice Address - Country:US
Practice Address - Phone:402-249-6136
Practice Address - Fax:402-502-6823
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006843207Q00000X, 208VP0000X
NE2886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine