Provider Demographics
NPI:1457363194
Name:ROESLER, DONALD J (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:ROESLER
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 1:1325 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1007
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:ATTN: P.F.S.
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-6428
Practice Address - Fax:605-322-6499
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR025309-0320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002363OtherSD BLUE CROSS PROV #
NE460224743-48Medicaid
MN143458600Medicaid
SDR025309OtherDAKOTACARE PROV #
IA2121590Medicaid
SD5751096Medicaid
MN013K6ROOtherMN BLUE CROSS PROV#
NE460224743-48Medicaid
SD5751096Medicaid