Provider Demographics
NPI:1639782733
Name:HUGGINS, MARESA GRINES (LPN)
Entity Type:Individual
Prefix:
First Name:MARESA
Middle Name:GRINES
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 7TH RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2582
Mailing Address - Country:US
Mailing Address - Phone:901-486-9969
Mailing Address - Fax:
Practice Address - Street 1:6939 7TH RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-2582
Practice Address - Country:US
Practice Address - Phone:901-486-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse