Provider Demographics
NPI:1801860390
Name:WADDILL, CYNTHIA K (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:WADDILL
Suffix:
Gender:F
Credentials:FNP
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7132
Mailing Address - Fax:843-777-4487
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:STE 500
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2772
Practice Address - Country:US
Practice Address - Phone:843-777-7900
Practice Address - Fax:843-777-7925
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0916Medicaid
SCP90569Medicare UPIN