Provider Demographics
NPI:1801067905
Name:HERMAN, KRISTIN OLDAG (RN,MSN,APNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:OLDAG
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RN,MSN,APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CARILLON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4616
Mailing Address - Country:US
Mailing Address - Phone:608-238-7234
Mailing Address - Fax:608-265-0605
Practice Address - Street 1:115 N ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1150
Practice Address - Country:US
Practice Address - Phone:608-262-8347
Practice Address - Fax:608-265-0605
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72277-030163WP0809X
WI833-033364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult