Provider Demographics
NPI:1083119143
Name:SHIRK, MORGAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:SHIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17812-9475
Mailing Address - Country:US
Mailing Address - Phone:570-541-0877
Mailing Address - Fax:
Practice Address - Street 1:4923 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17812-9475
Practice Address - Country:US
Practice Address - Phone:570-541-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer