Provider Demographics
NPI:1265871396
Name:D'AMORE, GABRIELLE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LYNN
Last Name:D'AMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:LYNN
Other - Last Name:MONIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3577 WEST 13 MILE ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-4244
Mailing Address - Fax:248-551-1094
Practice Address - Street 1:3577 WEST 13 MILE ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-4244
Practice Address - Fax:248-551-1094
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant