Healthcare Provider Details

I. General information

NPI: 1356744437
Provider Name (Legal Business Name): JESSICA HUGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6116 ECHO RD
ANIWA WI
54408-9636
US

IV. Provider business mailing address

E6116 ECHO RD
ANIWA WI
54408-9636
US

V. Phone/Fax

Practice location:
  • Phone: 715-571-7036
  • Fax:
Mailing address:
  • Phone: 715-571-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143559
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: