Provider Demographics
NPI:1023443306
Name:HODGES, CYNTHIA RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:HODGES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:RENEE
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8959 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3008
Mailing Address - Country:US
Mailing Address - Phone:773-600-5158
Mailing Address - Fax:
Practice Address - Street 1:125 S CLARK 12 TH FLOOR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603
Practice Address - Country:US
Practice Address - Phone:773-553-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.231910163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool