Provider Demographics
NPI:1134112378
Name:HIGGINS, MARY J (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:3728 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2841
Mailing Address - Country:US
Mailing Address - Phone:612-721-1057
Mailing Address - Fax:651-642-2523
Practice Address - Street 1:1619 DAYTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6206
Practice Address - Country:US
Practice Address - Phone:651-645-0478
Practice Address - Fax:651-642-2523
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR0967363367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife