Healthcare Provider Details

I. General information

NPI: 1689381204
Provider Name (Legal Business Name): MARISA J HIGGINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NA NA NA MARISA HIGGINS, RN

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 INTREPID AVE
PHILADELPHIA PA
19112-1229
US

IV. Provider business mailing address

9002 186TH AVE E APT E307
BONNEY LAKE WA
98391-8747
US

V. Phone/Fax

Practice location:
  • Phone: 253-862-2822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61199497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: