1093064164 NPI number — MS. MARY F HIGGINS FNP-BC

Table of content: MS. MARY F HIGGINS FNP-BC (NPI 1093064164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093064164 NPI number — MS. MARY F HIGGINS FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIGGINS
Provider First Name:
MARY
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093064164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 ESSEX RD
Provider Second Line Business Mailing Address:
LAHEY IPSWICH
Provider Business Mailing Address City Name:
IPSWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01938-2599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-356-5522
Provider Business Mailing Address Fax Number:
978-356-0218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 ESSEX RD
Provider Second Line Business Practice Location Address:
LAHEY IPSWICH
Provider Business Practice Location Address City Name:
IPSWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01938-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-356-5522
Provider Business Practice Location Address Fax Number:
978-356-0218
Provider Enumeration Date:
09/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN280911 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110095175A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com