MEDICARE: LEANDREA A SQUIRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.021673	OH
2	363LF0000X	Family Nurse Practitioner	APRN80756-NP-C	WV

General Provider Information

NPI Number	:	1730609942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDREA A SQUIRES

Provider Business Mailing Address
First Line	:	416 COLEGATE DR BLDG 3
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9549
Country	:	US
Telephone Number	:	740-374-3526
Fax Number	:	740-374-3165

Provider Business Practice Location Address
First Line	:	2434 RICHMILLER LN UNIT E
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1075
Country	:	US
Telephone Number	:	740-568-2243
Fax Number	:	740-374-4977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	03/16/2026

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Directions to “ LEANDREA A SQUIRES ” Practice Location

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