Provider Demographics
NPI:1215313911
Name:SCHORTGEN, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:SCHORTGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 N RUFUS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1162
Mailing Address - Country:US
Mailing Address - Phone:260-749-6706
Mailing Address - Fax:
Practice Address - Street 1:146 N RUFUS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1162
Practice Address - Country:US
Practice Address - Phone:260-749-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator