Provider Demographics
NPI:1275694564
Name:TRESCA, SALVATORE JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:TRESCA
Suffix:JR
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 1:22 MATHEW DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-1646
Mailing Address - Country:US
Mailing Address - Phone:401-349-4999
Mailing Address - Fax:
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2041
Practice Address - Country:US
Practice Address - Phone:860-456-9116
Practice Address - Fax:860-456-6748
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered