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Contact Information

MARK DUDLEY, APRN
1399 S 700 E STE 11B
SALT LAKE CITY, UT84105-2149
 Phone: 801-918-9890
 Fax: 801-466-3195
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatric/Mental Health, Adult

364SP0809X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for MARK DUDLEY · (Male)

NPI Number 1144223678
Status Active
Credentials APRN (Advanced Practice Registered Nurse)
Entity Individual
Enumeration date 05/30/2005
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • UT License # 1361364405
  • UT Other 94293834884047A017 CHAMPUS
  • UT Other 262137 DESERET MUTUAL
  • UT Other 107002906101 INTERMOUNTAIN HEALTH CARE
  • UT Other P33212 MEDICARE ADVANTAGE PLUS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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