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General NPI Number Information
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NPI Number | 1114206349
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Entity Type | Individual
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Provider Name | SHANIQUE RENEE RUBENS-WELCH ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR RM 4003
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City | YPSILANTI
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State | MI
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Zip | 48197-1099
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Country | US
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Telephone | 734-712-3470
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Fax | 734-712-2935
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Provider Business Mailing Address
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Address Line | 5333 MCAULEY DR RM 4003
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City | YPSILANTI
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State | MI
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Zip | 48197-1099
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Country | US
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Telephone | 734-712-3470
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Fax | 734-712-2935
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704252025
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704252025
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License Number State | MI
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