Provider Demographics
NPI:1033927421
Name:CIGANOVICH, BRIA (CRNA)
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:CIGANOVICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 HEIPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62940-2258
Mailing Address - Country:US
Mailing Address - Phone:618-559-5081
Mailing Address - Fax:
Practice Address - Street 1:405 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1462
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.469206163W00000X
IL209.031542367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse