Provider Demographics
NPI:1285873109
Name:HIGGINS, MARILYN JEAN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. OF NEUROLOGICAL SURGERY
Mailing Address - Street 2:T12 080 HEALTH SCIENCES CENTER
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF NEUROLOGICAL SURGERY
Practice Address - Street 2:T12 080 HEALTH SCIENCES CENTER
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301803363LA2200X
NYF381743-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics