Provider Demographics
NPI:1700399953
Name:GORESKI, ELISA M (CRNA, DNP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:GORESKI
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:M
Other - Last Name:RUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2320 W WABANSIA AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5302
Mailing Address - Country:US
Mailing Address - Phone:260-415-1879
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-834-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016886367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered