Healthcare Provider Details

I. General information

NPI: 1114834983
Provider Name (Legal Business Name): MELISSA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SW 43RD ST
RENTON WA
98057-4803
US

IV. Provider business mailing address

23000 MILITARY RD S APT 3218
KENT WA
98032-1968
US

V. Phone/Fax

Practice location:
  • Phone: 425-264-0750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70116698
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: