Provider Demographics
NPI:1720306541
Name:WILBANKS-ALLEN, CYNTHIA J
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:WILBANKS-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 N LOCKHART ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2939
Mailing Address - Country:US
Mailing Address - Phone:903-522-9348
Mailing Address - Fax:
Practice Address - Street 1:2332 N LOCKHART ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2939
Practice Address - Country:US
Practice Address - Phone:903-522-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies