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General NPI Number Information
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NPI Number | 1104320894
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Entity Type | Individual
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Provider Name | KRISTEN HERMANSON DO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 800 E 55TH ST
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City | CHICAGO
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State | IL
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Zip | 60615-4906
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Country | US
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Telephone | 312-682-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W HURON ST APT 317
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City | CHICAGO
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State | IL
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Zip | 60654-3943
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Country | US
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Telephone | 203-521-2996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.156703
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License Number State | IL
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