Provider Demographics
NPI:1588996573
Name:HIGGINS, SUSAN M (LPN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ACAPULCO ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1101
Mailing Address - Country:US
Mailing Address - Phone:516-668-4880
Mailing Address - Fax:
Practice Address - Street 1:90 ACAPULCO ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1101
Practice Address - Country:US
Practice Address - Phone:516-668-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258786164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse