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General NPI Number Information
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NPI Number | 1861736399
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Entity Type | Individual
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Provider Name | SUSAN E HERMANS NP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 14 TRI PARK WAY BLDG 2
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City | APPLETON
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State | WI
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Zip | 54914-6445
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Country | US
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Telephone | 920-831-0070
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Fax | 920-733-3822
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Provider Business Mailing Address
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Address Line | 14 TRI PARK WAY BLDG 2
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City | APPLETON
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State | WI
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Zip | 54914-6445
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Country | US
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Telephone | 920-831-0070
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Fax | 920-733-3822
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5019
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5019-33
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5019-33
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License Number State | WI
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