Provider Demographics
NPI:1871840058
Name:HERMES, DACIA L (NP)
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:L
Last Name:HERMES
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 1:1818 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-831-1890
Mailing Address - Fax:920-730-3433
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:THEDACARE PALLIATIVE CARE PROGRAM
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-731-4138
Practice Address - Fax:920-729-3021
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158970363L00000X
WI4935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner