Provider Demographics
NPI:1619982337
Name:SQUIRES, MAURA J (NP)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:J
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-4110
Mailing Address - Country:US
Mailing Address - Phone:413-276-6700
Mailing Address - Fax:413-301-7123
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-4110
Practice Address - Country:US
Practice Address - Phone:413-276-6700
Practice Address - Fax:413-301-7123
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA169613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA500025897OtherRAIL ROAD MEDICARE
MAS26781Medicare UPIN
MANP0655Medicare ID - Type Unspecified