Provider Demographics
NPI:1245315332
Name:HERMANSEN, LAYNE A (DO)
Entity type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:A
Last Name:HERMANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:877 E 12300 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:801-542-7111
Mailing Address - Fax:801-542-7112
Practice Address - Street 1:877 E 12300 S
Practice Address - Street 2:SUITE 201
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-542-7111
Practice Address - Fax:801-542-7112
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT58316971204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine