Provider Demographics
NPI:1073394680
Name:WILBORN, LONNIE
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:WILBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3457
Mailing Address - Country:US
Mailing Address - Phone:330-328-2350
Mailing Address - Fax:
Practice Address - Street 1:1235 ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3457
Practice Address - Country:US
Practice Address - Phone:330-328-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle