Provider Demographics
NPI:1962958298
Name:SHORT, COURTNEY (FNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 647
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0647
Mailing Address - Country:US
Mailing Address - Phone:701-452-3207
Mailing Address - Fax:701-452-2179
Practice Address - Street 1:1015 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-0647
Practice Address - Country:US
Practice Address - Phone:701-452-2364
Practice Address - Fax:701-452-4276
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily