Provider Demographics
NPI:1194614180
Name:HEREGO, MISRAK GEBRIE I (PROVIDER)
Entity type:Individual
Prefix:MISS
First Name:MISRAK
Middle Name:GEBRIE
Last Name:HEREGO
Suffix:I
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32223 25TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2508
Mailing Address - Country:US
Mailing Address - Phone:206-349-6892
Mailing Address - Fax:
Practice Address - Street 1:32223 25TH AVE SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2508
Practice Address - Country:US
Practice Address - Phone:206-349-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757264376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty