Provider Demographics
NPI:1902201403
Name:SHORT, DEANNA LEIGH (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEIGH
Last Name:SHORT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:141 N MAIN ST
Mailing Address - Street 2:STE # 205
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2011
Mailing Address - Country:US
Mailing Address - Phone:207-992-4032
Mailing Address - Fax:207-992-4034
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-992-4032
Practice Address - Fax:207-992-4034
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MERNA143051367500000X
NC184847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered