Provider Demographics
NPI:1538384672
Name:SHORTRIDGE, ALMA CHRISTINA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALMA
Middle Name:CHRISTINA
Last Name:SHORTRIDGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 MABERT RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:614-353-7130
Mailing Address - Fax:614-353-7130
Practice Address - Street 1:55 HYLAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629
Practice Address - Country:US
Practice Address - Phone:740-354-9343
Practice Address - Fax:740-354-9343
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN086246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2329546Medicare ID - Type Unspecified