Provider Demographics
NPI:1104280296
Name:TREBESCH, ERICA (CRNA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TREBESCH
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 1:310 PORT CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-2307
Mailing Address - Country:US
Mailing Address - Phone:605-222-2027
Mailing Address - Fax:
Practice Address - Street 1:801 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3323
Practice Address - Country:US
Practice Address - Phone:605-224-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000908367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered