Healthcare Provider Details

I. General information

NPI: 1114163110
Provider Name (Legal Business Name): DIXIE SHURLING MILLS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2008
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

802 NALLE ST
CHARLOTTESVILLE VA
22903-3426
US

V. Phone/Fax

Practice location:
  • Phone: 970-631-3479
  • Fax:
Mailing address:
  • Phone: 970-631-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200840578RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: