Provider Demographics
NPI:1114336153
Name:REISCH, MEGGAN LEIGH (CNP)
Entity type:Individual
Prefix:MRS
First Name:MEGGAN
Middle Name:LEIGH
Last Name:REISCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:MEGGAN
Other - Middle Name:LEIGH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:728 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3509
Mailing Address - Country:US
Mailing Address - Phone:605-556-1004
Mailing Address - Fax:217-771-1606
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:SD
Practice Address - Zip Code:57349-9064
Practice Address - Country:US
Practice Address - Phone:888-212-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR037821163W00000X
SDCP000920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD111436153Medicaid
1114336153Medicare NSC