Provider Demographics
NPI:1205006418
Name:SHIRK, DIANA DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:DAWN
Last Name:SHIRK
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 1:7256 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8230
Mailing Address - Country:US
Mailing Address - Phone:614-833-1094
Mailing Address - Fax:
Practice Address - Street 1:7256 PORTER DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8230
Practice Address - Country:US
Practice Address - Phone:614-833-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN256840163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse