Provider Demographics
NPI:1538800818
Name:HIGGINS, ELENA ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:ANN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3771
Mailing Address - Country:US
Mailing Address - Phone:978-927-0990
Mailing Address - Fax:
Practice Address - Street 1:16 FRONT ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3771
Practice Address - Country:US
Practice Address - Phone:978-927-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5264-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered