Provider Demographics
NPI:1194599167
Name:JUDE, SHIRRON
Entity type:Individual
Prefix:
First Name:SHIRRON
Middle Name:
Last Name:JUDE
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 1:2155 W MILL RD APT 208
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3462
Mailing Address - Country:US
Mailing Address - Phone:414-610-1886
Mailing Address - Fax:
Practice Address - Street 1:6801 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2820
Practice Address - Country:US
Practice Address - Phone:262-825-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing