Provider Demographics
NPI:1821038217
Name:GABEL, SHANNON C (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:GABEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:825 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1592
Practice Address - Country:US
Practice Address - Phone:989-732-1753
Practice Address - Fax:989-731-2100
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314309OtherBLUE CROSS BLUE SHIELD WY
MT4310527Medicaid
MI5601005656OtherMI LICENSE
WY117064300Medicaid
MT900213OtherBLUE CROSS BLUE SHIELD MT
WY314247OtherBLUE CROSS BLUE SHIELD WY
P15402Medicare UPIN
WY314309OtherBLUE CROSS BLUE SHIELD WY
MT900213OtherBLUE CROSS BLUE SHIELD MT
MT011000301Medicare PIN