MEDICARE: LESLIE ANN SHORTRIDGE F.N.P

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
1	363LF0000X	Family Nurse Practitioner	201605969NP-PP	OR
2	163W00000X	Registered Nurse	089006788RN	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089006788RN	OTHER	OR	OR NURSING LICENSE
2	201605969NP-PP	OTHER	OR	FNP LICENSE

General Provider Information

NPI Number	:	1861799165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN SHORTRIDGE F.N.P

Provider Business Mailing Address
First Line	:	PO BOX 4858
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4858
Country	:	US
Telephone Number	:	541-500-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-547-1369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	11/13/2020

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Directions to “ LESLIE ANN SHORTRIDGE F.N.P” Practice Location

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