Provider Demographics
NPI:1134125032
Name:SHORT, NANCY J (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4360 KENNEDY DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244
Mailing Address - Country:US
Mailing Address - Phone:309-792-6090
Mailing Address - Fax:309-792-6097
Practice Address - Street 1:4360 KENNEDY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4287
Practice Address - Country:US
Practice Address - Phone:309-743-7313
Practice Address - Fax:309-765-7999
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-11-18
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Provider Licenses
StateLicense IDTaxonomies
IL036103076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
151651OtherIOWA HEALTH SOLUTIONS
059704OtherHEALTH ALLIANCE
IL036103076Medicaid
IL01F5OtherJOHN DEERE HEALTH PLAN
080192373Medicare ID - Type UnspecifiedRAILROAD MEDICARE
151651OtherIOWA HEALTH SOLUTIONS
IL036103076Medicaid