Individual
LESLIE ANN SHORTRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P
Contact information
Practice address
1815 14TH AVE SE, ALBANY, OR 97322-8502
(541) 547-1369
Mailing address
PO BOX 4858, PORTLAND, OR 97208-4858
(541) 500-2555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
089006788RN
OR
363LF0000X
Family Nurse Practitioner
Primary
201605969NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089006788RN
OR NURSING LICENSE
OR
01
—
201605969NP-PP
FNP LICENSE
OR
Enumeration date
02/22/2011
Last updated
11/13/2020
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