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General NPI Number Information
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NPI Number | 1124476148
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Entity Type | Individual
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Provider Name | ALYSSA HIGGINS
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Gender | Female
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 1407 N VETERANS PKWY SUITE 12
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City | BLOOMINGTON
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State | IL
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Zip | 61704-6630
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Country | US
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Telephone | 309-661-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 901 SHERIDAN ST
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City | CHENOA
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State | IL
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Zip | 61726-1442
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Country | US
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Telephone | 309-530-0683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020.014749
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License Number State | IL
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