Healthcare Provider Details

I. General information

NPI: 1104280296
Provider Name (Legal Business Name): ERICA TREBESCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E SIOUX AVE
PIERRE SD
57501-3323
US

IV. Provider business mailing address

310 PORT CHARLOTTE AVE
FORT PIERRE SD
57532-2307
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-3100
  • Fax:
Mailing address:
  • Phone: 605-222-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000908
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: