Healthcare Provider Details

I. General information

NPI: 1396049649
Provider Name (Legal Business Name): MICHELLE M HERMES RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE M HERMES-SAGER

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

112 E COLLEGE AVE
APPLETON WI
54911-5741
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax: 920-993-5003
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number144415-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8007
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: