Basic Information
| Provider Information | |||||||||
| NPI: | 1134112378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3728 39TH AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554062841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127211057 | ||||||||
| FaxNumber: | 6516422523 | ||||||||
| Practice Location | |||||||||
| Address1: | 1619 DAYTON AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551046206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516450478 | ||||||||
| FaxNumber: | 6516422523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | R0967363 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.