Provider Demographics
NPI:1780300400
Name:WORTHY, LANARDO VINCHE SR
Entity type:Individual
Prefix:MR
First Name:LANARDO
Middle Name:VINCHE
Last Name:WORTHY
Suffix:SR
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 1:862 N FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2716
Mailing Address - Country:US
Mailing Address - Phone:330-338-4672
Mailing Address - Fax:
Practice Address - Street 1:862 N FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2716
Practice Address - Country:US
Practice Address - Phone:330-338-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSJ623689342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company