IndividualActive
Derrick Syvoravong
NPI 1376474999 · Student in an Organized Health Care Education/Training Program · Provo, UT
Provider details
- NPI number
- 1376474999
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Student, Health Care
Practice location
1800 Novell Pl
Provo, UT 84606-6171
Phone: (801) 375-5125
Approximate (ZIP-level) locationGet directions
Mailing address
1800 Novell Pl
Provo, UT 84606-6171
Registry dates
- Enumerated
- 2026-05-25
- Last updated
- 2026-05-25
- Certified
- 2026-05-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.