Healthcare Provider Details

I. General information

NPI: 1699318063
Provider Name (Legal Business Name): MARIA SQUETERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MEDICAL PARK DR SE
GRAND RAPIDS MI
49546-8323
US

IV. Provider business mailing address

2444 HAMPTON CT SE
GRAND RAPIDS MI
49546-6105
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-9610
  • Fax:
Mailing address:
  • Phone: 616-437-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704394712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: