Provider Demographics
NPI:1689853723
Name:HIGGINS, EDITH MARION (L AC)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:MARION
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:MARION HIGGINS
Other - Last Name:HAGELIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2120 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3700
Mailing Address - Country:US
Mailing Address - Phone:916-771-6619
Mailing Address - Fax:916-771-6630
Practice Address - Street 1:2120 PROFESSIONAL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3700
Practice Address - Country:US
Practice Address - Phone:916-771-6619
Practice Address - Fax:916-771-6630
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4275171100000X
OR0088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist