Healthcare Provider Details

I. General information

NPI: 1164496683
Provider Name (Legal Business Name): TRECIA D GULSETH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRECIA JENSEN

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-3007
US

IV. Provider business mailing address

1912 RIVER BEND ST
BRANDON SD
57005-3007
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8100
  • Fax: 608-262-6247
Mailing address:
  • Phone: 605-582-7014
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR030706
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0579
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD181494
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: