Provider Demographics
NPI:1437137882
Name:HIGGISON, MICHAEL (APRN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HIGGISON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5804
Mailing Address - Fax:860-224-5734
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5804
Practice Address - Fax:860-224-5734
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health