Provider Demographics
NPI:1699197467
Name:COREY, MARY ELIZABETH WEAVER (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH WEAVER
Last Name:COREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6542
Mailing Address - Country:US
Mailing Address - Phone:704-230-1302
Mailing Address - Fax:708-230-1284
Practice Address - Street 1:118 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6542
Practice Address - Country:US
Practice Address - Phone:704-230-1302
Practice Address - Fax:704-230-1284
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant