Provider Demographics
NPI:1871896431
Name:WAAGE, RYANNE L (PA-C)
Entity type:Individual
Prefix:
First Name:RYANNE
Middle Name:L
Last Name:WAAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RYANNE
Other - Middle Name:L
Other - Last Name:BROCKHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3 LAFAYETTE ST S
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-5524
Mailing Address - Country:US
Mailing Address - Phone:605-226-0560
Mailing Address - Fax:605-226-1653
Practice Address - Street 1:3 LAFAYETTE ST S
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5524
Practice Address - Country:US
Practice Address - Phone:605-226-0560
Practice Address - Fax:605-226-1653
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant