Individual
TYLER G HIGGINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(715) 256-3000
Mailing address
2109B E CAPITOL DR STE 1, APPLETON, WI 54911-8726
(920) 202-3371
(920) 939-3827
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3410-33
WI
367500000X
Certified Registered Nurse Anesthetist
R79716
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011417052
DRIVERS LICENSE
SC
Enumeration date
11/17/2006
Last updated
11/24/2021
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