Provider Demographics
NPI:1417302472
Name:GAUVIN, SHAWN (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18128 CEDAR ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9582
Mailing Address - Country:US
Mailing Address - Phone:313-549-3570
Mailing Address - Fax:
Practice Address - Street 1:18128 CEDAR ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-9582
Practice Address - Country:US
Practice Address - Phone:313-549-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212742363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care