Healthcare Provider Details

I. General information

NPI: 1053402388
Provider Name (Legal Business Name): CHARLOTTE ILENE SYGIT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E SANILAC RD
SANDUSKY MI
48471-1383
US

IV. Provider business mailing address

512 PEBBLE LN
PORT SANILAC MI
48469-9777
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-0300
  • Fax:
Mailing address:
  • Phone: 810-404-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704226157
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: