Provider Demographics
NPI:1295471670
Name:HODGES, ELESA (RN)
Entity Type:Individual
Prefix:
First Name:ELESA
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4537
Mailing Address - Country:US
Mailing Address - Phone:708-537-7733
Mailing Address - Fax:
Practice Address - Street 1:139 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-4537
Practice Address - Country:US
Practice Address - Phone:708-537-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.504397163WC1600X, 163WC2100X, 163WD0400X, 163WG0600X, 163WH1000X, 163WI0600X, 163WP0000X, 163WW0000X, 163WX1500X, 163WH0200X
ID041.504397163WH0500X, 163WN1003X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No172A00000XOther Service ProvidersDriver