Basic Information
| Provider Information | |||||||||
| NPI: | 1023541851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDENS | ||||||||
| FirstName: | ALEXANDERIA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1443 W 800 N STE 103 | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840572878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016554950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 448 E WINCHESTER ST | ||||||||
| Address2: | SUITE 200, COMMERCE PARK BUILDING #4 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841077591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012800413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2017 | ||||||||
| LastUpdateDate: | 04/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.