Provider Demographics
NPI:1861736399
Name:HERMANS, SUSAN E (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HERMANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TRI PARK WAY BLDG 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6445
Mailing Address - Country:US
Mailing Address - Phone:920-831-0070
Mailing Address - Fax:920-733-3822
Practice Address - Street 1:14 TRI PARK WAY BLDG 2
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6445
Practice Address - Country:US
Practice Address - Phone:920-831-0070
Practice Address - Fax:920-733-3822
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5019363L00000X
WI5019-33363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health