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NPI Code Detail

MEDICARE: WENDY DIANE SHORT

MEDICARE: WENDY DIANE 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1679905814
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY DIANE SHORT
Provider Business Mailing Address
First Line : 1728 S CARSON AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4610
Country : US
Telephone Number : 918-936-6127
Fax Number :
Provider Business Practice Location Address
First Line : 1728 S CARSON AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4610
Country : US
Telephone Number : 918-523-0428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2013
Last Update Date : 03/17/2025

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Directions to “ WENDY DIANE SHORT ” Practice Location

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