Provider Demographics
NPI:1902095060
Name:HIGGINS, LARYSSA DAWN
Entity Type:Individual
Prefix:
First Name:LARYSSA
Middle Name:DAWN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:FAIRACRES
Mailing Address - State:NM
Mailing Address - Zip Code:88033-1467
Mailing Address - Country:US
Mailing Address - Phone:575-680-0018
Mailing Address - Fax:
Practice Address - Street 1:1805 AMIS AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1651
Practice Address - Country:US
Practice Address - Phone:575-680-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator