Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | R31662 | ND |
Y | 363LG0600X | Nurse Practitioner - Gerontology | R31662 | ND |
NPI | 1013503911 |
---|---|
Provider Name | Lee Ann June Short |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Bismarck, ND 58501-4439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2020 |
Last Update Date | 31/03/2021 |