Provider Demographics
NPI:1821038217
Name:GABEL, SHANNON CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTINE
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 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2386
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:
Practice Address - Street 1:829 N CENTER AVE STE 120
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1598
Practice Address - Country:US
Practice Address - Phone:989-731-7987
Practice Address - Fax:989-731-9151
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-02-07
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
WY117064300Medicaid
MT4310527Medicaid
MT900213OtherBLUE CROSS BLUE SHIELD MT
WY314247OtherBLUE CROSS BLUE SHIELD WY
WY314309OtherBLUE CROSS BLUE SHIELD WY
MI5601005656OtherMI LICENSE
P15402Medicare UPIN
WY314309OtherBLUE CROSS BLUE SHIELD WY
MT900213OtherBLUE CROSS BLUE SHIELD MT
MT011000301Medicare PIN