Provider Demographics
NPI:1548406275
Name:SHORTRIDGE, MATTHEW N (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:SHORTRIDGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12845
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-0017
Mailing Address - Country:US
Mailing Address - Phone:704-830-1362
Mailing Address - Fax:704-866-7853
Practice Address - Street 1:1550 UNION RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5522
Practice Address - Country:US
Practice Address - Phone:704-864-8772
Practice Address - Fax:704-866-7853
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189356367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered