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Individual

CHARLES KIP DEWEESE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
82 S 1100 E, SUITE 204, SALT LAKE CITY, UT 84102-1686
(801) 350-4602
Mailing address
82 S 1100 E, SUITE 204, SALT LAKE CITY, UT 84102-1686
(801) 350-4602

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
206077-4405
UT

Other

Enumeration date
10/03/2006
Last updated
10/20/2021
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