Provider Demographics
NPI:1811997935
Name:SQUIRES, TERRI LEIGH (NP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LEIGH
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SW METOLIUS AVE APT 260
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6755
Mailing Address - Country:US
Mailing Address - Phone:808-866-6533
Mailing Address - Fax:888-338-7728
Practice Address - Street 1:3600 SW METOLIUS AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6754
Practice Address - Country:US
Practice Address - Phone:808-866-6533
Practice Address - Fax:888-338-7728
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1028363LF0000X, 363LP0808X
CO5346363LF0000X, 363LP0808X
CO7086363LP0808X
OR201709332NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH104655Medicare UPIN
COCOA108455Medicare UPIN
CO87485249Medicaid