Provider Demographics
NPI:1740234020
Name:DICK, DAVID OWEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:OWEN
Last Name:DICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 CORNWELL LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2517
Mailing Address - Country:US
Mailing Address - Phone:757-496-2419
Mailing Address - Fax:757-496-2419
Practice Address - Street 1:1504 CORNWELL LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2517
Practice Address - Country:US
Practice Address - Phone:757-496-2419
Practice Address - Fax:757-496-2419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered