Provider Demographics
NPI:1104798792
Name:SQUIRES, WILSHAWNDA
Entity type:Individual
Prefix:
First Name:WILSHAWNDA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARMYCE
Other - Middle Name:
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3771 RAMSEY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9314
Practice Address - Country:US
Practice Address - Phone:910-900-6003
Practice Address - Fax:910-900-7004
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC8097374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide