Provider Demographics
NPI:1619053188
Name:HIGGS, MARY K (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:HIGGS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:M.
Other - Middle Name:KRISTIN
Other - Last Name:HIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:304 W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-898-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN209002872367A00000X
IL209002872367A00000X
IN09000385A367A00000X
IL277000648363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208905126Medicare PIN
ILP15057Medicare UPIN
ILIL3270513Medicare PIN
IL6447860011Medicare PIN