Provider Demographics
NPI:1336523760
Name:SHORT, LORI (APN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S. CICERO, SUITE 320
Mailing Address - Street 2:ADULT PRIMARY CARE CENTER, LTD.
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-636-1601
Mailing Address - Fax:
Practice Address - Street 1:10837 S. CICERO, SUITE 320
Practice Address - Street 2:ADULT PRIMARY CARE CENTER, LTD.
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-636-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-012886363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health