Provider Demographics
NPI:1144518879
Name:HERMUS, RYAN J (APNP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:HERMUS
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7863
Mailing Address - Country:US
Mailing Address - Phone:920-454-8401
Mailing Address - Fax:920-993-5037
Practice Address - Street 1:3925 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7863
Practice Address - Country:US
Practice Address - Phone:920-454-8401
Practice Address - Fax:920-993-5037
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158574-30163W00000X
WI4537-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse