Provider Demographics
NPI:1831147586
Name:HODGES, PHLESIA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:PHLESIA
Middle Name:ANN
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 1:2270 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9338
Mailing Address - Country:US
Mailing Address - Phone:262-375-4135
Mailing Address - Fax:262-375-4135
Practice Address - Street 1:4422 N 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-5104
Practice Address - Country:US
Practice Address - Phone:414-535-9717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38202600Medicaid