Healthcare Provider Details

I. General information

NPI: 1659946390
Provider Name (Legal Business Name): GABRIELLE CONWAY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE IN
46845-1673
US

IV. Provider business mailing address

1448 10TH AVE STE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-6780
  • Fax: 260-425-6615
Mailing address:
  • Phone: 304-733-8728
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4678
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number02008971A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: