Provider Demographics
NPI:1629333190
Name:WELGRAVEN, SHANNA MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MICHELE
Last Name:WELGRAVEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:MICHELE
Other - Last Name:ROMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:303-861-4914
Mailing Address - Fax:303-861-8615
Practice Address - Street 1:2060 DAN PROCTOR DR STE 1200
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3895
Practice Address - Country:US
Practice Address - Phone:912-540-6750
Practice Address - Fax:912-540-6773
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66710207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology