Provider Demographics
NPI:1114206349
Name:RUBENS-WELCH, SHANIQUE RENEE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:RENEE
Last Name:RUBENS-WELCH
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:SHANIQUE
Other - Middle Name:RENEE
Other - Last Name:RUBENS-WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:RM 4003
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1099
Mailing Address - Country:US
Mailing Address - Phone:734-712-3470
Mailing Address - Fax:734-712-2935
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:RM 4003
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1099
Practice Address - Country:US
Practice Address - Phone:734-712-3470
Practice Address - Fax:734-712-2935
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252025363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse