Provider Demographics
NPI:1568905297
Name:SHORT, DANA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:WOODS- SHORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:21015 REBECCA HILL CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21015 REBECCA HILL CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7073
Practice Address - Country:US
Practice Address - Phone:817-323-5736
Practice Address - Fax:832-917-0786
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308107164X00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide