Provider Demographics
NPI:1407235260
Name:SHORT, MARGO A (RN)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:A
Last Name:SHORT
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 1:2043 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1724
Mailing Address - Country:US
Mailing Address - Phone:716-298-1777
Mailing Address - Fax:716-298-1707
Practice Address - Street 1:2043 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1724
Practice Address - Country:US
Practice Address - Phone:716-298-1777
Practice Address - Fax:716-298-1707
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse