Healthcare Provider Details

I. General information

NPI: 1861763591
Provider Name (Legal Business Name): MICHELLE DIANE SQUIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 SHADYSIDE DR
HUBBARD OH
44425-1365
US

IV. Provider business mailing address

3315 SHADYSIDE DR
HUBBARD OH
44425-1365
US

V. Phone/Fax

Practice location:
  • Phone: 330-766-3519
  • Fax:
Mailing address:
  • Phone: 330-766-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: