Healthcare Provider Details

I. General information

NPI: 1053096172
Provider Name (Legal Business Name): JESSI HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3213
US

IV. Provider business mailing address

41 MERRILL ST
PORTLAND ME
04101-3213
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-5773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-311197
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: