Provider Demographics
NPI:1447011242
Name:SHORTER, LOKEY TRUMAN II
Entity type:Individual
Prefix:
First Name:LOKEY
Middle Name:TRUMAN
Last Name:SHORTER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8389 TROWBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1371
Mailing Address - Country:US
Mailing Address - Phone:937-380-4074
Mailing Address - Fax:
Practice Address - Street 1:8389 TROWBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1371
Practice Address - Country:US
Practice Address - Phone:937-380-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant