Provider Demographics
NPI:1992143481
Name:SHORT, MEGAN NICOLE
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:RENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:895 ROBERTA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6802
Mailing Address - Country:US
Mailing Address - Phone:775-331-6252
Mailing Address - Fax:775-331-6250
Practice Address - Street 1:895 ROBERTA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6802
Practice Address - Country:US
Practice Address - Phone:775-331-6252
Practice Address - Fax:775-331-6250
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor