Provider Demographics
NPI:1912951872
Name:WILBORNE, CYNTHIA M (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:WILBORNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1759
Mailing Address - Country:US
Mailing Address - Phone:434-792-4041
Mailing Address - Fax:434-792-0124
Practice Address - Street 1:101 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1759
Practice Address - Country:US
Practice Address - Phone:434-792-4041
Practice Address - Fax:434-792-0124
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024116437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010133386Medicaid
VA010133386Medicaid