Provider Demographics
NPI:1669611893
Name:LUBONOVICH, TERRY LYNN (CNP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:LUBONOVICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2214
Mailing Address - Country:US
Mailing Address - Phone:330-534-3436
Mailing Address - Fax:
Practice Address - Street 1:ONE PERKINS SQUARE
Practice Address - Street 2:AKRON CHILDRENS HOSPITAL
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308
Practice Address - Country:US
Practice Address - Phone:330-543-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08971363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics