Individual
MR. MARK DUDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1399 S 700 E STE 11B, SALT LAKE CITY, UT 84105-2149
(801) 918-9890
(801) 466-3195
Mailing address
2386 SNOW MOUNTAIN DR, SANDY, UT 84093-1753
(801) 733-4376
(801) 466-3195
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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