Healthcare Provider Details

I. General information

NPI: 1679592414
Provider Name (Legal Business Name): NANCY A. SQUIRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY A SQUIRE M.D.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 SW GRANDSTAND CIR
LEES SUMMIT MO
64081-3866
US

IV. Provider business mailing address

PO BOX 875743
KANSAS CITY MO
64187-5743
US

V. Phone/Fax

Practice location:
  • Phone: 913-215-5008
  • Fax: 816-817-1299
Mailing address:
  • Phone: 913-215-5008
  • Fax: 816-817-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113740
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: