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NPI Code Detail

MEDICARE: PAULINE A SHORT

MEDICARE:   PAULINE A SHORT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376J00000XHomemaker

General Provider Information

NPI Number : 1851996136
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINE A SHORT
Provider Business Mailing Address
First Line : 361 SUGAR RUN RD
Second Line :
City : COTTAGEVILLE
State : WV
Zip : 25239-6555
Country : US
Telephone Number : 304-372-2498
Fax Number : 304-471-2488
Provider Business Practice Location Address
First Line : 1222 MARKET ST
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-4323
Country : US
Telephone Number : 304-865-5420
Fax Number : 304-865-5423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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Directions to “ PAULINE A SHORT ” Practice Location

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