Provider Demographics
NPI:1730842592
Name:SHORT, LORI A (FNP-BC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:ESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - Street 2:2520 ELISHA AVENUE
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily