Provider Demographics
NPI:1427221449
Name:MCQUISTEN, BETH ANDREA (CRNA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANDREA
Last Name:MCQUISTEN
Suffix:
Gender:F
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:PO BOX 5045
Mailing Address - Street 2:ATTN: PFS PROV ENROLLMENT
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR027438367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5755750Medicaid
SDP00671163OtherRAILROAD MEDICARE
SD9260694OtherDAKOTACARE
MN1427221449Medicaid
1427221449OtherMN BCBS
NE46022474348OtherNEBRASKA MEDICAID
SD1427221449OtherWELLMARK BCBS OF SD
SDS102446Medicare PIN