Provider Demographics
NPI:1235803172
Name:SHULENBERGER, COLLEEN MEGAN (CPM, LM)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MEGAN
Last Name:SHULENBERGER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 OLD BULLARD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4362
Mailing Address - Country:US
Mailing Address - Phone:903-707-8505
Mailing Address - Fax:903-309-1030
Practice Address - Street 1:5528 OLD BULLARD RD STE 110
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4362
Practice Address - Country:US
Practice Address - Phone:903-707-8505
Practice Address - Fax:903-309-1030
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99454176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife