Provider Demographics
NPI:1528457645
Name:HERMSEN HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:HERMSEN HEALTH AND WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-371-2702
Mailing Address - Street 1:8791 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1719
Mailing Address - Country:US
Mailing Address - Phone:952-447-0985
Mailing Address - Fax:952-447-0986
Practice Address - Street 1:6880 BOUDIN ST NE STE 230
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1510
Practice Address - Country:US
Practice Address - Phone:952-447-0985
Practice Address - Fax:952-447-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350005214OtherMEDICARE PTAN
MN1043555055OtherINDIVIDUAL PROVIDER NPI