Provider Demographics
NPI:1477846616
Name:HOGABOOM, GABRIELLE ELIZABETH (CSA)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:ELIZABETH
Last Name:HOGABOOM
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W MICHIGAN ST
Mailing Address - Street 2:APT 238
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3226
Mailing Address - Country:US
Mailing Address - Phone:561-371-7959
Mailing Address - Fax:
Practice Address - Street 1:310 W MICHIGAN ST
Practice Address - Street 2:APT 238
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3226
Practice Address - Country:US
Practice Address - Phone:561-371-7959
Practice Address - Fax:561-371-7959
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3718246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant