Provider Demographics
NPI:1306434857
Name:VOWELL, SHANIN RAE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:SHANIN
Middle Name:RAE
Last Name:VOWELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 E 4TH AVE # 2-126
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8735
Mailing Address - Country:US
Mailing Address - Phone:720-507-4779
Mailing Address - Fax:
Practice Address - Street 1:14221 E 4TH AVE # 2-330
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8735
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171924163WP0808X
COC-APN.0002874-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health