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NPI Code Detail

MEDICARE: DIANNA ELIZABETH WINE PA-C

MEDICARE: DIANNA ELIZABETH WINE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA055676PA
2363A00000XPhysician Assistant25MP00257500NJ
3363A00000XPhysician Assistant0110008014VA

General Provider Information

NPI Number : 1609155977
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNA ELIZABETH WINE PA-C
Provider Business Mailing Address
First Line : PO BOX 631863
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-1863
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14163 MIDLOTHIAN TPKE
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23113-6523
Country : US
Telephone Number : 804-893-8702
Fax Number : 804-767-5755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 06/12/2025

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