Individual
GWENDOLYN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
142 E. DEARBORN, UNION, OR 97883-0986
(541) 562-6062
(541) 562-5757
Mailing address
425 20TH AVE S, MINNEAPOLIS, MN 55454-4400
(612) 332-4973
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200750114NP FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139449
—
OR
01
—
200750114NP FNP-PP
OSBN LICENSURE
—
Enumeration date
06/20/2006
Last updated
03/07/2023
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