Individual
JACLYN WHITNEY SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3455 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239
(970) 420-5017
Mailing address
3455 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-3076
(970) 420-5017
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.0195636
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
201801406CRNA-PP
OR
Other
Enumeration date
09/18/2015
Last updated
08/18/2018
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