Healthcare Provider Details

I. General information

NPI: 1447042940
Provider Name (Legal Business Name): JOSIE ANN HERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 MILWAUKEE ST
MADISON WI
53714-2132
US

IV. Provider business mailing address

829 CHRISTIANSON AVE
MADISON WI
53714-1104
US

V. Phone/Fax

Practice location:
  • Phone: 608-446-9495
  • Fax:
Mailing address:
  • Phone: 608-630-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number109653-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number109653-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: