Provider Demographics
NPI:1265815237
Name:MINOR, GABRIELLE ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ROSE
Last Name:MINOR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ROSE
Other - Last Name:MICKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2525 9TH AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2014
Mailing Address - Country:US
Mailing Address - Phone:814-943-7546
Mailing Address - Fax:814-943-7543
Practice Address - Street 1:2525 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2014
Practice Address - Country:US
Practice Address - Phone:814-943-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057675363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical