Individual
MARY SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2412 E WASHINGTON ST STE 4A, BLOOMINGTON, IL 61704-1613
(309) 585-2116
(309) 585-2152
Mailing address
2412 E WASHINGTON ST STE 4A, BLOOMINGTON, IL 61704-1613
(309) 585-2116
(309) 585-2152
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041415946
IL
Other
Enumeration date
03/23/2026
Last updated
03/23/2026
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