Healthcare Provider Details

I. General information

NPI: 1487579025
Provider Name (Legal Business Name): KRISTINA HERMANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 WI-167
RICHFIELD WI
53076
US

IV. Provider business mailing address

3110 STATE ROAD 83
HARTFORD WI
53027-9004
US

V. Phone/Fax

Practice location:
  • Phone: 262-628-1032
  • Fax:
Mailing address:
  • Phone: 414-943-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number257736-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: