Dudley, Mark
Dudley, Mark is an sole proprietor health care provider with primary practice located at 1399 S 700 E Ste 11B , Salt Lake City UT 84105-2149. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Adult, which is considered as his primary health care specialty. Dudley, Mark can be contacted via phone (801) 918-9890.Contact Information
Primary practice address
1399 S 700 E Ste 11B
Salt Lake City UT 84105-2149
Phone: (801) 918-9890
Fax: (801) 466-3195
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Adult | 364SP0809X | 1361364405 | Utah |
Profile Details
| NPI number | 1144223678 |
|---|---|
| LBN Legal business name | Dudley, Mark |
| Credentials | Advanced Practice Registered Nurse (APRN) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 30th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144223678 | NPPES |
| Utah | Other | 94293834884047A017 | CHAMPUS |
| Utah | Other | 107002906101 | CHAMPUS |
| Utah | Other | 262137 | CHAMPUS |
| Utah | Other | P33212 | CHAMPUS |
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