Provider Demographics
NPI:1467949982
Name:HERMANSON, CHAD ANTON
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ANTON
Last Name:HERMANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9004 W WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-8331
Mailing Address - Country:US
Mailing Address - Phone:608-921-0960
Mailing Address - Fax:
Practice Address - Street 1:9004 W WHEELER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-8331
Practice Address - Country:US
Practice Address - Phone:608-921-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other