Provider Demographics
NPI:1326362898
Name:SHORTS, MARY JO (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:SHORTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:MC GRAW
Mailing Address - State:NY
Mailing Address - Zip Code:13101-0118
Mailing Address - Country:US
Mailing Address - Phone:607-758-6110
Mailing Address - Fax:607-758-6116
Practice Address - Street 1:49 GRANT ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2136
Practice Address - Country:US
Practice Address - Phone:607-753-6751
Practice Address - Fax:607-756-4306
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY552969163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health