Healthcare Provider Details

I. General information

NPI: 1114206349
Provider Name (Legal Business Name): SHANIQUE RENEE RUBENS-WELCH ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANIQUE RENEE RUBENS-WELCH

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 4003
YPSILANTI MI
48197-1099
US

IV. Provider business mailing address

5333 MCAULEY DR RM 4003
YPSILANTI MI
48197-1099
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3470
  • Fax: 734-712-2935
Mailing address:
  • Phone: 734-715-1706
  • Fax: 734-869-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704252025
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704252025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: