Provider Demographics
NPI:1386810489
Name:SHORT, COLLEEN E (APRN)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:E
Last Name:SHORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3410 N 156TH ST
Practice Address - Street 2:ATTN: QUICK CARE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2020
Practice Address - Country:US
Practice Address - Phone:800-253-4368
Practice Address - Fax:402-614-5733
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110878363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098611197OtherMEDICARE PTAN
NE098611197OtherMEDICARE PTAN