Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2019-00125 | NC |
NPI | 1053708446 |
---|---|
Provider Name | Samantha Shirk |
First Address | New Salisbury, IN 47161-8301 |
Second Address | Cincinnati, OH 45220-2475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 19/06/2019 |