Provider Demographics
NPI:1881341394
Name:WEAVER, GABRIELLE SHEAANN (DMS, PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:SHEAANN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DMS, PA-C
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMS, PA-C
Mailing Address - Street 1:931 E 86TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1852
Mailing Address - Country:US
Mailing Address - Phone:317-257-1484
Mailing Address - Fax:317-257-1488
Practice Address - Street 1:931 E 86TH ST STE 104
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1852
Practice Address - Country:US
Practice Address - Phone:317-257-1484
Practice Address - Fax:317-257-1488
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004047A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant