Healthcare Provider Details

I. General information

NPI: 1871840058
Provider Name (Legal Business Name): DACIA L HERMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST THEDACARE PALLIATIVE CARE PROGRAM
NEENAH WI
54956-2883
US

IV. Provider business mailing address

1818 N MEADE ST
APPLETON WI
54911-3454
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-4138
  • Fax: 920-729-3021
Mailing address:
  • Phone: 920-831-1890
  • Fax: 920-730-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number158970
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4935
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: