Provider Demographics
NPI:1851197628
Name:CANTLEBERRY, ALAYNA GRACE
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:GRACE
Last Name:CANTLEBERRY
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 1:2112 E ENOCH LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-7128
Mailing Address - Country:US
Mailing Address - Phone:509-294-4268
Mailing Address - Fax:
Practice Address - Street 1:2112 E ENOCH LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7128
Practice Address - Country:US
Practice Address - Phone:509-294-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program