Provider Demographics
NPI:1457320988
Name:GABLE, PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GABLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1011 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8735
Mailing Address - Country:US
Mailing Address - Phone:231-779-2565
Mailing Address - Fax:231-775-0744
Practice Address - Street 1:1011 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8735
Practice Address - Country:US
Practice Address - Phone:231-779-2565
Practice Address - Fax:231-775-0744
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704109747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4841883Medicaid
MIQ63874Medicare UPIN
MI0N17550016Medicare PIN