Provider Demographics
NPI:1699446229
Name:SQUIRES, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 HILLCREST WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2989
Mailing Address - Country:US
Mailing Address - Phone:310-498-3154
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE STE N
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0581
Practice Address - Country:US
Practice Address - Phone:310-498-3154
Practice Address - Fax:206-483-0118
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60866866163W00000X
WAARNP.AP.70016732-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse