Provider Demographics
NPI:1962010009
Name:HUGHES, ELISA MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 LOCUST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1517
Mailing Address - Country:US
Mailing Address - Phone:304-366-4750
Mailing Address - Fax:
Practice Address - Street 1:445 W MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2843
Practice Address - Country:US
Practice Address - Phone:304-842-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV59631163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management