Provider Demographics
NPI:1942069869
Name:SQUIRES, LEAH (RN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2933
Mailing Address - Country:US
Mailing Address - Phone:315-255-8486
Mailing Address - Fax:
Practice Address - Street 1:191 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2933
Practice Address - Country:US
Practice Address - Phone:315-255-8486
Practice Address - Fax:315-282-2824
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY846156163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool