Provider Demographics
NPI:1558387449
Name:HIGGINS, DIANNE LORY (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LORY
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-0805
Mailing Address - Country:US
Mailing Address - Phone:530-271-3232
Mailing Address - Fax:530-271-3239
Practice Address - Street 1:880 ALDER AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8335
Practice Address - Country:US
Practice Address - Phone:775-831-5308
Practice Address - Fax:775-831-3295
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42102207P00000X
NV10165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A421021Medicaid
NV100503371Medicaid
10165OtherNV STATE LICENSE
A29506Medicare UPIN
CA00A421021Medicaid