Individual
LORI A. ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5230 E STOP 11 RD STE 150, INDIANAPOLIS, IN 46237-6399
(317) 865-5904
(317) 865-5321
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28188944A
IN
363LF0000X
Family Nurse Practitioner
Primary
71006300A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201364110
—
IN
Enumeration date
01/21/2016
Last updated
10/18/2023
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