Provider Demographics
NPI:1477884153
Name:SHORT, DAWN (RRT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IL
Mailing Address - Zip Code:60966-8301
Mailing Address - Country:US
Mailing Address - Phone:309-846-1310
Mailing Address - Fax:
Practice Address - Street 1:390 E CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IL
Practice Address - Zip Code:60966-8301
Practice Address - Country:US
Practice Address - Phone:309-846-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL194.006617227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered