Provider Demographics
NPI:1962043638
Name:BECKSTRAND, TYREL JAN (CRNA)
Entity Type:Individual
Prefix:
First Name:TYREL
Middle Name:JAN
Last Name:BECKSTRAND
Suffix:
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 1:139 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2728
Mailing Address - Country:US
Mailing Address - Phone:435-660-1502
Mailing Address - Fax:
Practice Address - Street 1:9127 W RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1240
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV824547367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV824547OtherNEVADA STATE BOARD OF NURSING