Provider Demographics
NPI:1467524306
Name:SQUIBB, SHARON DEBORA (CNM)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DEBORA
Last Name:SQUIBB
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DEBORA
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-6869
Mailing Address - Fax:515-643-6899
Practice Address - Street 1:330 LAUREL ST STE 2300
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-643-6869
Practice Address - Fax:515-643-6899
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNM-78A367A00000X
IAB-119773367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7633OtherACNM CERTIFICATION NUMBER