Provider Demographics
NPI:1588351837
Name:WIRGES, SHAYNA MARIE
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:MARIE
Last Name:WIRGES
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 1:3745 S 77TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4708
Mailing Address - Country:US
Mailing Address - Phone:402-540-2349
Mailing Address - Fax:
Practice Address - Street 1:2320 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5515
Practice Address - Country:US
Practice Address - Phone:402-218-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician