Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 53-75214-101 | KS |
Y | 363L00000X | Nurse Practitioner | 53-75214-101 | KS |
NPI | 1033428735 |
---|---|
Provider Name | Anna Laurel Short |
First Address | Saint Louis, MO 63128-2786 |
Second Address | Overland Park, KS 66211-1363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01050323 | RAILROAD MEDICARE (01) |