Provider Demographics
NPI:1578663605
Name:HIGGINS, RUSSETTE ANN (RNCWHNP)
Entity Type:Individual
Prefix:MS
First Name:RUSSETTE
Middle Name:ANN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:RNCWHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 E HYDE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8418
Mailing Address - Country:US
Mailing Address - Phone:989-224-4897
Mailing Address - Fax:
Practice Address - Street 1:615 N STATE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-831-5237
Practice Address - Fax:989-831-5522
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704087519363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704087519OtherSTATE LICENSE