Healthcare Provider Details

I. General information

NPI: 1124050810
Provider Name (Legal Business Name): ELISA R. RHODES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 US HIGHWAY 41 STE I
SCHERERVILLE IN
46375-1278
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-3950
  • Fax: 219-864-3952
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001267A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: