Individual
SHANNON L WELNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
60 POMPTON AVE, VERONA, NJ 07044-2946
(973) 571-2121
(973) 571-2126
Mailing address
60 POMPTON AVE, VERONA, NJ 07044-2946
(973) 571-2121
(973) 571-2126
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00146000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962428474
GROUP NPI NUMBER
NJ
01
—
25MP00146000
STATE LICENSE
NJ
Enumeration date
05/25/2007
Last updated
07/08/2007
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