Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2056 | ME |
N | 207Q00000X | Family Doctor | DO2056 | ME |
NPI | 1306953450 |
---|---|
Provider Name | Shawn M Higgins |
First Address | Portland, ME 04103-2141 |
Second Address | Portland, ME 04103-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 26/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000818501 | (02) | ME |
1205155611 | OSTEOPATHIC WELLNESS, LLC (01) | ME |