Healthcare Provider Details

I. General information

NPI: 1861736399
Provider Name (Legal Business Name): SUSAN E HERMANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TRI PARK WAY BLDG 2
APPLETON WI
54914-6445
US

IV. Provider business mailing address

14 TRI PARK WAY BLDG 2
APPLETON WI
54914-6445
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-0070
  • Fax: 920-733-3822
Mailing address:
  • Phone: 920-831-0070
  • Fax: 920-733-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5019-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5019-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: