Individual
ALYSSA HIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 N VETERANS PKWY, SUITE 12, BLOOMINGTON, IL 61704-6630
(309) 661-2999
Mailing address
901 SHERIDAN ST, CHENOA, IL 61726-1442
(309) 530-0683
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020.014749
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-1340371
—
IL
Enumeration date
05/31/2016
Last updated
05/31/2016
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