Provider Demographics
NPI:1134373368
Name:HERMAN, JANINE I (RCP-70-028)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:I
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RCP-70-028
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11649 N. PORT WASHINGTON RD # 109
Mailing Address - Street 2:ENDEAVOR THERAPY
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53024
Mailing Address - Country:US
Mailing Address - Phone:262-241-8892
Mailing Address - Fax:262-241-8894
Practice Address - Street 1:11649 N. PORT WASHINGTON RD # 109
Practice Address - Street 2:ENDEAVOR THERAPY
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53024
Practice Address - Country:US
Practice Address - Phone:262-241-8892
Practice Address - Fax:262-241-8894
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40076000Medicaid
WI524505Medicare Oscar/Certification