Provider Demographics
NPI:1821804931
Name:HIGUERA, PAMALA (NP)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:HIGUERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WAVERLY PARK RD
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-4424
Mailing Address - Country:US
Mailing Address - Phone:508-649-3588
Mailing Address - Fax:
Practice Address - Street 1:233 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1786
Practice Address - Country:US
Practice Address - Phone:508-807-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN250718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner