Provider Demographics
NPI:1760670970
Name:SQUIRES, MELISSA LEIGH (FNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LEIGH
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 ENON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5912
Mailing Address - Country:US
Mailing Address - Phone:804-536-4269
Mailing Address - Fax:866-616-0686
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9942
Practice Address - Fax:804-874-1008
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily