Healthcare Provider Details

I. General information

NPI: 1396881504
Provider Name (Legal Business Name): JULIE MARIE SHIRK R.N.F.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SENECA ST
VENTURA CA
93001-4460
US

IV. Provider business mailing address

702 SENECA ST
VENTURA CA
93001-4460
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-9146
  • Fax:
Mailing address:
  • Phone: 805-643-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number269797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: