Provider Demographics
NPI:1164496683
Name:GULSETH, TRECIA D (CRNA)
Entity Type:Individual
Prefix:
First Name:TRECIA
Middle Name:D
Last Name:GULSETH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRECIA
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 RIVER BEND ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-3007
Mailing Address - Country:US
Mailing Address - Phone:605-582-7014
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1912 RIVER BEND ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-3007
Practice Address - Country:US
Practice Address - Phone:605-582-7014
Practice Address - Fax:605-328-6512
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0579367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5754330Medicaid
SD5754330Medicaid
SCS41699Medicare PIN