Provider Demographics
NPI:1598568560
Name:SQUIRES, DEWANN
Entity type:Individual
Prefix:
First Name:DEWANN
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 E 56TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2231
Mailing Address - Country:US
Mailing Address - Phone:463-710-1439
Mailing Address - Fax:
Practice Address - Street 1:9105 E 56TH ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2231
Practice Address - Country:US
Practice Address - Phone:463-710-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health