Individual
ANICETTE PROTACIO DEZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
10800 MIDLOTHIAN TPKE, SUITE 265, RICHMOND, VA 23235-4724
(804) 594-2622
(804) 594-0915
Mailing address
3131 SHOREWOOD PL, MIDLOTHIAN, VA 23112-3091
(804) 763-6570
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
0001146339
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024169186
VA
367A00000X
Advanced Practice Midwife
367A00000X
VA
Other
Enumeration date
12/05/2010
Last updated
12/11/2012
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