Provider Demographics
NPI:1639814262
Name:HERMANSEN, KAYLEE A
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:A
Last Name:HERMANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 JESSAMINE AVE W APT 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2637
Mailing Address - Country:US
Mailing Address - Phone:608-576-0310
Mailing Address - Fax:
Practice Address - Street 1:1425 JESSAMINE AVE W APT 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2637
Practice Address - Country:US
Practice Address - Phone:608-576-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer