1821038217 NPI number — SHANNON CHRISTINE GABEL PA-C

Table of content: SHANNON CHRISTINE GABEL PA-C (NPI 1821038217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821038217 NPI number — SHANNON CHRISTINE GABEL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABEL
Provider First Name:
SHANNON
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821038217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 SIXTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-731-7708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
829 N CENTER AVE STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-1598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-731-7987
Provider Business Practice Location Address Fax Number:
989-731-9151
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  249 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117064300 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4310527 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900213 . This is a "BLUE CROSS BLUE SHIELD MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 314247 . This is a "BLUE CROSS BLUE SHIELD WY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 314309 . This is a "BLUE CROSS BLUE SHIELD WY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 5601005656 . This is a "MI LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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