Provider Demographics
NPI:1124085964
Name:HERMRECK, CONSTANCE DENISE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:DENISE
Last Name:HERMRECK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3439 THOMAS ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66092
Mailing Address - Country:US
Mailing Address - Phone:785-250-1803
Mailing Address - Fax:785-350-4535
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:VA EASTERN KANSAS
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:785-350-4535
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSARNP44572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161071Medicare ID - Type Unspecified