Healthcare Provider Details

I. General information

NPI: 1073022430
Provider Name (Legal Business Name): SHANNON WELKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E ARAPAHOE RD
CENTENNIAL CO
80122-2312
US

IV. Provider business mailing address

850 PRAIRIE RIDGE RD
HIGHLANDS RANCH CO
80126-2038
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-4545
  • Fax:
Mailing address:
  • Phone: 720-312-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0174073
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: