MEDICARE: MS. MARY R HIGGINS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	041-232830	IL

General Provider Information

NPI Number	:	1558353292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY R HIGGINS CRNA

Provider Business Mailing Address
First Line	:	225 N COLUMBUS DR
Second Line	:	UNIT 6005
City	:	CHICAGO
State	:	IL
Zip	:	60601-7910
Country	:	US
Telephone Number	:	630-853-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E ERIE ST
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	312-649-3939
Fax Number	:	312-649-5747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	04/12/2010

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