Provider Demographics
NPI:1629421706
Name:HERMANSON, BETH (CNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:HERMANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:741 MOUNTAIN VIEW RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:741 MOUNTAIN VIEW RD STE 1
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2539
Practice Address - Country:US
Practice Address - Phone:605-791-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCP001110OtherSOUTH DAKOTA STATE BOARD OF NURSING