1578663605 NPI number — MS. RUSSETTE ANN HIGGINS RNC.WHNP

Table of content: MS. RUSSETTE ANN HIGGINS RNC.WHNP (NPI 1578663605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578663605 NPI number — MS. RUSSETTE ANN HIGGINS RNC.WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIGGINS
Provider First Name:
RUSSETTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC.WHNP
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:
1578663605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1746 E HYDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOHNS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48879-8418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-224-4897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48888-9702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-831-5237
Provider Business Practice Location Address Fax Number:
989-831-5522
Provider Enumeration Date:
09/25/2006

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: 363LW0102X , with the licence number:  4704087519 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4704087519 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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