Healthcare Provider Details

I. General information

NPI: 1992178099
Provider Name (Legal Business Name): ANNA SHORT CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE MERCY PLAZA STE 251
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

1225 S GEAR AVE MERCY PLAZA STE 251
WEST BURLINGTON IA
52655-1691
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3700
  • Fax: 319-768-3712
Mailing address:
  • Phone: 319-768-3700
  • Fax: 319-768-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05110
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: