Provider Demographics
NPI:1992770010
Name:WEGEHAUPT, DANIEL J (CRNA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:WEGEHAUPT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 S CATHEDRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7614
Mailing Address - Country:US
Mailing Address - Phone:605-941-4282
Mailing Address - Fax:605-747-3628
Practice Address - Street 1:BIA ROUTE 1, SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-2216
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5750493Medicaid
SD5750493Medicaid
SDS41165Medicare PIN