Gavin, Shannon Michele

Gavin, Shannon Michele is an individual health care provider with primary practice located at 407 W Indiana Ave , Chesterton IN 46304-2350. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Gavin, Shannon Michele can be contacted via phone (219) 763-8112.

Contact Information

Primary practice address
407 W Indiana Ave Chesterton IN 46304-2350
Phone: (219) 763-8112
Fax: (219) 764-5384
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2010007825 Indiana

Profile Details

NPI number 1801199070
LBN Legal business name Gavin, Shannon Michele
Credentials MSN, RN, FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 9th, 2010
Last updated May 26th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801199070 NPPES
Indiana MEDICAID 201015570
Indiana Other 71003579A

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