Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6004 | TN |
NPI | 1003441023 |
---|---|
Provider Name | Lori Denise Higgins |
First Address | Adamsville, TN 38310-5066 |
Second Address | Adamsville, TN 38310-5066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |