Provider Demographics
NPI:1760463715
Name:SQUIRES, JOYCE EVET
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:EVET
Last Name:SQUIRES
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 1:170 OUTER LOOP ROAD
Mailing Address - Street 2:USAMEDDAC KAHC ATTN: CREDENTIALS OFFICE
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-2780
Mailing Address - Fax:760-380-7101
Practice Address - Street 1:3962 DRINKWATER ST
Practice Address - Street 2:USAMEDDAC WAHC
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1507
Practice Address - Country:US
Practice Address - Phone:760-380-2780
Practice Address - Fax:760-380-7101
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY437600-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse