Provider Demographics
NPI:1982674693
Name:WRINKLE, DANA GREGORY (CRNA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:GREGORY
Last Name:WRINKLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEIGH
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:1211 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1313
Practice Address - Country:US
Practice Address - Phone:336-272-0101
Practice Address - Fax:336-272-4063
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC144993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052049Medicaid
NC2604305AMedicare ID - Type Unspecified