Provider Demographics
NPI:1932644853
Name:SHORT, KRISTEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44873 CORTE CASA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1603
Mailing Address - Country:US
Mailing Address - Phone:951-972-0484
Mailing Address - Fax:
Practice Address - Street 1:44873 CORTE CASA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-1603
Practice Address - Country:US
Practice Address - Phone:951-972-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711645163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care