Provider Demographics
NPI:1295077782
Name:MARKLE, SHANNON GAIL (CNM)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:GAIL
Last Name:MARKLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W 100 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9230
Mailing Address - Country:US
Mailing Address - Phone:219-628-6452
Mailing Address - Fax:
Practice Address - Street 1:413 W 100 N
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9230
Practice Address - Country:US
Practice Address - Phone:219-628-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000227A367A00000X
IN71004370A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife