Provider Demographics
NPI:1053701862
Name:SQUIRES, LATONYA
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4550 STRUTFIELD LN
Mailing Address - Street 2:UNIT 2425
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-4965
Mailing Address - Country:US
Mailing Address - Phone:301-789-2161
Mailing Address - Fax:
Practice Address - Street 1:4550 STRUTFIELD LN
Practice Address - Street 2:UNIT 2425
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-4965
Practice Address - Country:US
Practice Address - Phone:301-789-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN67911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse