Provider Demographics
NPI:1194565721
Name:ROSE, ABIGAYLE ELYSE (CGC)
Entity type:Individual
Prefix:
First Name:ABIGAYLE
Middle Name:ELYSE
Last Name:ROSE
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 4700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2285
Mailing Address - Country:US
Mailing Address - Phone:317-948-5450
Mailing Address - Fax:317-968-1256
Practice Address - Street 1:355 W 16TH ST STE 4700
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2285
Practice Address - Country:US
Practice Address - Phone:317-948-5450
Practice Address - Fax:317-968-1256
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99124896A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS