Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704177641 | MI |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704177641 | MI |
NPI | 1023356748 |
---|---|
Provider Name | Mrs. Deborah Lee Squire |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2013 |
Last Update Date | 05/08/2020 |