Provider Demographics
NPI:1073022430
Name:WELKER, SHANNON (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WELKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 PRAIRIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2038
Mailing Address - Country:US
Mailing Address - Phone:720-312-3537
Mailing Address - Fax:
Practice Address - Street 1:5555 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2312
Practice Address - Country:US
Practice Address - Phone:303-344-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0174073163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty