Provider Demographics
NPI:1184860983
Name:SQUIERS, AMANDA NICOLE (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:NICOLE
Last Name:SQUIERS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:FULLERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:7150 W SUNSET RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-442-1886
Practice Address - Street 1:7500 SMOKE RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0373
Practice Address - Country:US
Practice Address - Phone:702-233-4727
Practice Address - Fax:702-233-4799
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61623307363LA2200X
OR201404840NP-PP363LA2200X
TNAPN13902363LA2200X
NV825927363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health