Provider Demographics
NPI:1275223117
Name:SQUARE, VALERY MARYELLEN
Entity Type:Individual
Prefix:
First Name:VALERY
Middle Name:MARYELLEN
Last Name:SQUARE
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 1:155 CONESTOGA ST
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-2263
Mailing Address - Country:US
Mailing Address - Phone:223-667-4238
Mailing Address - Fax:717-828-4845
Practice Address - Street 1:155 CONESTOGA ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2263
Practice Address - Country:US
Practice Address - Phone:223-667-4238
Practice Address - Fax:717-828-4845
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA247000000X
372500000X
PA96C08A27C81842EFBB393747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No372500000XNursing Service Related ProvidersChore Provider