Provider Demographics
NPI:1407852163
Name:HIGGINS, JOANNE MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W GERMANTOWN PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1062
Mailing Address - Country:US
Mailing Address - Phone:610-525-4966
Mailing Address - Fax:
Practice Address - Street 1:1200 MANOR DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2282
Practice Address - Country:US
Practice Address - Phone:116-326-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN273344L367500000X
PARN273344L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA048202Medicare ID - Type Unspecified