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General NPI Number Information
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NPI Number | 1326362898
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Entity Type | Individual
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Provider Name | MARY JO SHORTS RN
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Gender | Female
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 49 GRANT ST
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City | CORTLAND
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State | NY
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Zip | 13045-2136
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Country | US
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Telephone | 607-753-6751
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Fax | 607-756-4306
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Provider Business Mailing Address
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Address Line | PO BOX 118
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City | MC GRAW
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State | NY
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Zip | 13101-0118
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Country | US
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Telephone | 607-758-6110
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Fax | 607-758-6116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 552969
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License Number State | NY
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