Provider Demographics
NPI:1396037172
Name:GLEASON, SHAWNA R (DO)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:R
Last Name:GLEASON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 HARBOR HILLS DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8977
Mailing Address - Country:US
Mailing Address - Phone:906-262-0400
Mailing Address - Fax:906-273-1278
Practice Address - Street 1:1007 HARBOR HILLS DR STE B
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8977
Practice Address - Country:US
Practice Address - Phone:906-262-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine