Provider Demographics
NPI:1003034216
Name:SHIRK, NANCY A
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:SHIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8026 S 85TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8571
Mailing Address - Country:US
Mailing Address - Phone:414-425-4884
Mailing Address - Fax:414-525-2798
Practice Address - Street 1:107 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-1801
Practice Address - Country:US
Practice Address - Phone:920-892-7788
Practice Address - Fax:920-893-5459
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI962-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)