MEDICARE: CYNTHIA K. WADDILL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN 2721	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801860390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA K. WADDILL FNP

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-777-7132
Fax Number	:	843-777-4487

Provider Business Practice Location Address
First Line	:	901 E CHEVES ST
Second Line	:	STE 500
City	:	FLORENCE
State	:	SC
Zip	:	29506-2772
Country	:	US
Telephone Number	:	843-777-7900
Fax Number	:	843-777-7925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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