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Individual
SHANNON MICHELE GAVIN
Active
Individual
SHANNON MICHELE GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010007825
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201015570
—
IN
01
—
71003579A
LICENSE
IN
Enumeration date
12/09/2010
Last updated
05/26/2016
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