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General NPI Number Information
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NPI Number | 1013615566
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Entity Type | Individual
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Provider Name | MICHELLE LAUREN SQUIRES PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 11006 SPENCER HWY
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City | LA PORTE
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State | TX
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Zip | 77571-4416
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Country | US
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Telephone | 281-470-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 MANZANITA LN
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City | MANVEL
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State | TX
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Zip | 77578-3958
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Country | US
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Telephone | 405-532-5080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16443
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License Number State | TX
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