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General NPI Number Information
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NPI Number | 1003034216
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Entity Type | Individual
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Provider Name | MRS. NANCY A SHIRK
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 107 DIVISION ST
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City | PLYMOUTH
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State | WI
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Zip | 53073-1801
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Country | US
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Telephone | 920-892-7788
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Fax | 920-893-5459
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Provider Business Mailing Address
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Address Line | 8026 S 85TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-8571
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Country | US
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Telephone | 414-425-4884
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Fax | 414-525-2798
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 962-132
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License Number State | WI
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