Healthcare Provider Details

I. General information

NPI: 1427697622
Provider Name (Legal Business Name): DAVID DURANT DINSMORE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATRIUM HEALTH PINEVILLE 10628 PARK ROAD
CHARLOTTE NC
28210
US

IV. Provider business mailing address

14310 GREEN BIRCH DR
PINEVILLE NC
28134-9040
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-1000
  • Fax:
Mailing address:
  • Phone: 919-358-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number128642
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: