Individual
MARK DUWAYNE DEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6154 S 2175 E, OGDEN, UT 84403-5354
(801) 726-3738
Mailing address
6154 S 2175 E, OGDEN, UT 84403-5354
(801) 726-3738
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
56634973102
UT
363LF0000X
Family Nurse Practitioner
Primary
5663497-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275134132
COMMERCIAL INSURANCE
UT
05
—
1275134132
—
UT
Enumeration date
10/27/2021
Last updated
10/18/2022
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