Provider Demographics
NPI:1215221312
Name:SHORTINO, SUSAN DIANE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:SHORTINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COHASSET RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2260
Mailing Address - Country:US
Mailing Address - Phone:530-891-2945
Mailing Address - Fax:
Practice Address - Street 1:500 COHASSET RD
Practice Address - Street 2:SUITE 15
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2260
Practice Address - Country:US
Practice Address - Phone:530-891-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse