Provider Demographics
NPI:1235843186
Name:CYGAN, EDITHA
Entity Type:Individual
Prefix:
First Name:EDITHA
Middle Name:
Last Name:CYGAN
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 1:1225 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8332
Mailing Address - Country:US
Mailing Address - Phone:701-941-1968
Mailing Address - Fax:
Practice Address - Street 1:1225 WHITETAIL DR
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8332
Practice Address - Country:US
Practice Address - Phone:701-941-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1753374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-1753OtherSC LICENCE