MEDICARE: MRS. REBECCA SQUIER NP

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	0024186507	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024186507	OTHER	VA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1912604356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA SQUIER NP

Provider Business Mailing Address
First Line	:	3084 R AND L SMITH DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-7858
Country	:	US
Telephone Number	:	434-713-1618
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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