Provider Demographics
NPI:1366135931
Name:EUSEBIO, HERMENIGILDA ANG (FNP)
Entity type:Individual
Prefix:
First Name:HERMENIGILDA
Middle Name:ANG
Last Name:EUSEBIO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 S MERIDIAN STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1654
Mailing Address - Country:US
Mailing Address - Phone:253-445-7600
Mailing Address - Fax:253-864-5999
Practice Address - Street 1:2930 S MERIDIAN STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1654
Practice Address - Country:US
Practice Address - Phone:253-445-7600
Practice Address - Fax:253-864-5999
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187189363LF0000X
WAAP61592114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2314753Medicaid