Provider Demographics
NPI:1083021893
Name:HERBERT, ALAYNA
Entity Type:Individual
Prefix:
First Name:ALAYNA
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N STATE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1313
Mailing Address - Country:US
Mailing Address - Phone:435-619-4398
Mailing Address - Fax:
Practice Address - Street 1:1800 N STATE ST APT 102
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1313
Practice Address - Country:US
Practice Address - Phone:435-619-4398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator