Provider Demographics
NPI:1851563175
Name:HIGGINS, LORETTA ANN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LORETTA
Middle Name:ANN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 PACIFIC AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2877
Mailing Address - Country:US
Mailing Address - Phone:503-357-3074
Mailing Address - Fax:
Practice Address - Street 1:2305 PACIFIC AVE STE A
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2877
Practice Address - Country:US
Practice Address - Phone:503-357-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3839247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other