Provider Demographics
NPI:1083162523
Name:KUBIAK, SHIRLEY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 BLUEBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2618
Mailing Address - Country:US
Mailing Address - Phone:608-334-1481
Mailing Address - Fax:
Practice Address - Street 1:W6440 E PINE ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:WI
Practice Address - Zip Code:53926-9375
Practice Address - Country:US
Practice Address - Phone:920-394-2136
Practice Address - Fax:920-394-2021
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87336-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse