Provider Demographics
NPI:1366404543
Name:WINT, BONNIE LEE (CRNA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:WINT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LEE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:501 HAMPTON ROADS GASTROENTEROLOGY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6080
Practice Address - Country:US
Practice Address - Phone:757-826-3434
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166001367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01168429OtherRAILROAD MEDICARE
VAQ42522AOtherPALMETTO MEDICARE
VA010184142Medicaid
VA1366404543Medicaid
VAP01168429OtherRAILROAD MEDICARE
VA010184142Medicaid