Healthcare Provider Details

I. General information

NPI: 1992632012
Provider Name (Legal Business Name): YESENIA HERMOSILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

PO BOX 1374
GLENROCK WY
82637-1374
US

V. Phone/Fax

Practice location:
  • Phone: 206-452-8325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number51825
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: