Individual
MRS. JENNIFER LEA SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
50 NORTHGATE INDUSTRIAL DR, GRANITE CITY, IL 62040-6805
(618) 877-4420
Mailing address
6190 BENNETT DR APT 114, EDWARDSVILLE, IL 62025-4731
(618) 830-0993
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.028657
IL
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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