Individual
DAKOTA M. WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-5051
(804) 628-6990
(804) 628-6932
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024175754
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
541581185
CRNA
VA
Enumeration date
01/23/2018
Last updated
04/02/2018
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