Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 10877423-4810 | UT |
N | 213ES0000X | Sports Medicine | 10877423-4810 | UT |
NPI | 1215493838 |
---|---|
Provider Name | Nikole Decker Squires |
First Address | Provo, UT 84601-2436 |
Second Address | Highland, UT 84003-3455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10877423-4810 | UT DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING (01) | UT |
2000031617 | NATIONAL ATHLETIC TRAINERS' ASSOCIATION BOARD OF CERTIFICATION, INC. (01) | |
TBA | NATIONAL ACADEMY OF SPORTS MEDICINE (01) |