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Individual
MR. MARK DUDLEY
Active
Individual
MR. MARK DUDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
1361364405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107002906101
INTERMOUNTAIN HEALTH CARE
UT
01
—
262137
DESERET MUTUAL
UT
01
—
94293834884047A017
CHAMPUS
UT
01
—
P33212
MEDICARE ADVANTAGE PLUS
UT
Enumeration date
05/30/2005
Last updated
07/08/2007
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