Provider Demographics
NPI:1932649944
Name:TANCIG, MARY (ELECTROLOGIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TANCIG
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HOKAI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6206
Mailing Address - Country:US
Mailing Address - Phone:808-875-7070
Mailing Address - Fax:
Practice Address - Street 1:115 E LIPOA ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8182
Practice Address - Country:US
Practice Address - Phone:808-875-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIEL 40246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other