Provider Demographics
NPI:1467663781
Name:KIRK, ALBERTA LOUISE
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:LOUISE
Last Name:KIRK
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 1:7335 N RIDGE RD
Mailing Address - Street 2:APT # A1
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2653
Mailing Address - Country:US
Mailing Address - Phone:440-428-5123
Mailing Address - Fax:
Practice Address - Street 1:7335 N RIDGE RD
Practice Address - Street 2:APT # A1
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2653
Practice Address - Country:US
Practice Address - Phone:440-428-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide