Provider Demographics
NPI:1437987849
Name:DERENGE, MEGAN GRACE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:GRACE
Last Name:DERENGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 S ARWAY DRIVE
Mailing Address - Street 2:SIOUX FALLS SD 57108
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106
Mailing Address - Country:US
Mailing Address - Phone:605-573-2000
Mailing Address - Fax:
Practice Address - Street 1:4308 S ARWAY DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3131
Practice Address - Country:US
Practice Address - Phone:605-573-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health