Provider Demographics
NPI:1407993009
Name:SHORT, EMILY CLAIRE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 SE HAWTHORNE BLVD
Mailing Address - Street 2:APT #43
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3871
Mailing Address - Country:US
Mailing Address - Phone:503-804-5520
Mailing Address - Fax:
Practice Address - Street 1:1232 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2906
Practice Address - Country:US
Practice Address - Phone:503-227-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion