Provider Demographics
NPI:1225727019
Name:SHORTER, VINNETA (NP)
Entity Type:Individual
Prefix:
First Name:VINNETA
Middle Name:
Last Name:SHORTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNS GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-1110
Mailing Address - Country:US
Mailing Address - Phone:856-308-9495
Mailing Address - Fax:
Practice Address - Street 1:121 BECKS WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3852
Practice Address - Country:US
Practice Address - Phone:302-834-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0010628363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care