Provider Demographics
NPI:1023389392
Name:MERGEN, LEAH AYN (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:AYN
Last Name:MERGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N MAIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5947
Mailing Address - Country:US
Mailing Address - Phone:605-367-8793
Mailing Address - Fax:
Practice Address - Street 1:521 N MAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5947
Practice Address - Country:US
Practice Address - Phone:605-367-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0799363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6837110Medicaid
SD6837112Medicaid
SD6837112Medicaid