Provider Demographics
NPI:1720355217
Name:HIGGINS, LEANNE BETH KOLOSOVSKY (RN)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:BETH KOLOSOVSKY
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4102
Mailing Address - Country:US
Mailing Address - Phone:414-350-6328
Mailing Address - Fax:
Practice Address - Street 1:3366 S 35TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4102
Practice Address - Country:US
Practice Address - Phone:414-350-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136731-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse