Provider Demographics
NPI:1558353292
Name:HIGGINS, MARY R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:TAPAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 N COLUMBUS DR
Mailing Address - Street 2:UNIT 6005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7910
Mailing Address - Country:US
Mailing Address - Phone:630-853-8388
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:312-649-3939
Practice Address - Fax:312-649-5747
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-232830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11259/205395Medicare ID - Type Unspecified
IL215536001Medicare PIN
ILQ26179Medicare UPIN