Provider Demographics
NPI:1346353281
Name:SQUYRES, SARA ANNE (PA-C, MPAS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANNE
Last Name:SQUYRES
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SQUYRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-417-7111
Mailing Address - Fax:360-417-7342
Practice Address - Street 1:840 N 5TH AVE STE 1500
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-582-2841
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60071584363A00000X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant