Provider Demographics
NPI:1710933510
Name:SQUIRES, ELIZABETH R (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HWY 18 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8478
Mailing Address - Country:US
Mailing Address - Phone:336-372-4095
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 508
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-264-9007
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC056647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse