Provider Demographics
NPI:1356488589
Name:DELANGE, JEANNIE L (NP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:L
Last Name:DELANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:L
Other - Last Name:GROENEWEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:27658 381ST AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:SD
Mailing Address - Zip Code:57328-5317
Mailing Address - Country:US
Mailing Address - Phone:605-680-1587
Mailing Address - Fax:
Practice Address - Street 1:27658 381ST AVE
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:SD
Practice Address - Zip Code:57328-5317
Practice Address - Country:US
Practice Address - Phone:605-680-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19622Medicaid
ND18275Medicare PIN
NDS82431Medicare UPIN