Provider Demographics
NPI:1225086408
Name:DERRINGER, PENNY K (PA-C)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:K
Last Name:DERRINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAREN
Other - Middle Name:LEE
Other - Last Name:DERRINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1821 S STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2257
Mailing Address - Country:US
Mailing Address - Phone:608-260-6000
Mailing Address - Fax:608-260-6939
Practice Address - Street 1:1821 S STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2257
Practice Address - Country:US
Practice Address - Phone:608-260-6000
Practice Address - Fax:608-260-6161
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI702-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3059OtherDEAN HEALTH INSURANCE
WI42936800Medicaid
S56824Medicare UPIN
WI970010924Medicare PIN
WI050274150Medicare PIN
WI543400527Medicare PIN