Provider Demographics
NPI:1013746890
Name:HIGGINS, ELIZA REGINA (CPM, LM)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:REGINA
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1636
Mailing Address - Country:US
Mailing Address - Phone:307-271-2363
Mailing Address - Fax:
Practice Address - Street 1:1109 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1636
Practice Address - Country:US
Practice Address - Phone:307-271-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI561-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife