Provider Demographics
NPI:1770311003
Name:HERMANSON, DALTON TREY
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:TREY
Last Name:HERMANSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:DALTON
Other - Last Name:GEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD # MS 2027
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-3974
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 2027
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program