Individual
DIONNE MICHELLE TYREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805
(804) 765-5000
Mailing address
3998 FAIR RIDGE DR, SUITE 300, FAIRFAX, VI 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001138871
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024168660
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427389709
—
VA
Enumeration date
01/26/2010
Last updated
04/16/2015
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