Provider Demographics
NPI:1104171040
Name:FROST-HIGGINS, MARIANNE ELIZABETH (MA)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:FROST-HIGGINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4790 BURCH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4124
Mailing Address - Country:US
Mailing Address - Phone:801-663-3890
Mailing Address - Fax:
Practice Address - Street 1:4790 BURCH CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4124
Practice Address - Country:US
Practice Address - Phone:801-663-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4930736-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11539353OtherCAQH