Provider Demographics
NPI:1326291576
Name:HANDLER, SHANNON I (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:I
Last Name:HANDLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:I
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6500
Mailing Address - Fax:
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-01
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271882363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM28290052Medicare PIN