Healthcare Provider Details

I. General information

NPI: 1104960012
Provider Name (Legal Business Name): JEANNIE HIGGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TYRE AVE
NEWARK DE
19711-7136
US

IV. Provider business mailing address

716 SEYMOUR RD
BEAR DE
19701-1164
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2047
  • Fax:
Mailing address:
  • Phone: 302-743-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL10028251
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000965
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: