Provider Demographics
NPI:1679592414
Name:SQUIRE, NANCY A (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:SQUIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-817-1299
Practice Address - Street 1:3066 SW GRANDSTAND CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3866
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-817-1299
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204623615Medicaid
H24848Medicare UPIN
H24848Medicare UPIN