Provider Demographics
NPI:1295212652
Name:SQUALLS, LINDA FAYE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:FAYE
Last Name:SQUALLS
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 1:6901 S MCCLINTOCK DR APT 238
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4190
Mailing Address - Country:US
Mailing Address - Phone:219-588-7162
Mailing Address - Fax:
Practice Address - Street 1:6901 S MCCLINTOCK DR APT 238
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4190
Practice Address - Country:US
Practice Address - Phone:219-588-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN214182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse