Provider Demographics
NPI:1972308716
Name:GAMBOA MORALES, WENDY EDITH (PA-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:EDITH
Last Name:GAMBOA MORALES
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2995
Mailing Address - Country:US
Mailing Address - Phone:317-880-3838
Mailing Address - Fax:317-880-0130
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2995
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0130
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004747A363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical