MR. MARK DUDLEY (NPI# 1144223678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144223678 |
| Entity Type | Individual |
| Full Name | MR. MARK DUDLEY |
| Other Name | MARK DUDLEY |
| Credential | APRN |
| Practice Address |
1399 S 700 E Ste 11b Salt Lake City UT 84105-2149 |
| Mailing Address |
2386 Snow Mountain Dr Sandy UT 84093-1753 |
| Practice Telephone | 8019189890 |
| Practice Fax Number | 8014663195 |
| Mailing Telephone | 8017334376 |
| Mailing Fax Number | 8014663195 |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
1361364405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | DESERET MUTUAL | 262137 | 01 |
| UT | MEDICARE ADVANTAGE PLUS | P33212 | 01 |
| UT | INTERMOUNTAIN HEALTH CARE | 107002906101 | 01 |
| UT | CHAMPUS | 94293834884047A017 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689784019 | Mark Dudley | Chiropractor | 1053 E 2100 S, Salt Lake City, UT 84106-2349 | 2006-08-30 |
| 1356484828 | Mark Brian Dudley | Family Medicine | 655 7th St Bldg 700700-a, Warner Robins, GA 31098-2227 | 2007-02-15 |
| Street Address |
1399 S 700 E STE 11B |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84105-2149 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285106237 | Laiyan H Bawadeen | Counselor | 1425 700 E Suite #102, Salt Lake City, UT 84105 | 2018-12-31 |
| 1639644255 | Claire Elizabeth Gray | Marriage & Family Therapist | 1425 700 East, Salt Lake City, UT 84105 | 2018-10-10 |
| 1083089643 | Celisa Packer | Social Worker | 2020 E Lake St, Salt Lake City, UT 84105 | 2015-12-08 |
| 1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
| 1649548355 | Leland Burt Cowan | Surgery | 1405 Princeton Ave, Salt Lake City, UT 84105 | 2011-12-08 |
| 1639460355 | Sally Cathleen Webster | Counselor | 1248 Yale Avenue, Salt Lake City, UT 84105 | 2011-04-28 |
| 1912205105 | Melissa Wilson | Case Manager/Care Coordinator | 1522 S 1100 E, Salt Lake City, UT 84105 | 2011-03-11 |
| 1013215789 | Tamara Marie Wright | Counselor | 1996 Lake St, Salt Lake City, UT 84105 | 2011-03-04 |
| 1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
| 1508011180 | Keith Elliott | Anesthesiology | 1552 South 1000 East, Salt Lake City, UT 84105 | 2008-11-24 |
| Find all providers in zip 84105 | ||||
| Taxonomy Code | 364SP0809X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285736926 | Marie Kathleen Acree | Clinical Nurse Specialist | 650 E 4500 S, Suite 300, Salt Lake City, UT 84107-2900 | 2006-09-02 |
| 1154383206 | Carolyn Louise Anich | Clinical Nurse Specialist | 500 Foothill Blvd, Salt Lake City, UT 84148-0001 | 2006-04-04 |
| 1417934324 | Rebecca Lucille | Clinical Nurse Specialist | 5965 S 900 E, Suite 240, Salt Lake City, UT 84121-1720 | 2005-12-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467606228 | Marilyn Louise Little | Clinical Nurse Specialist | 198 W 7200 S, Midvale, UT 84047-3749 | 2008-11-06 |
| 1922202282 | Robin Jacobs | Clinical Nurse Specialist | 1174 E Graystone Way Ste 4, Slc, UT 84106-2671 | 2007-06-12 |
| 1154408805 | Lynne L Gagon | Clinical Nurse Specialist | 147 E Main St, Vernal, UT 84078-2643 | 2006-11-01 |
| 1063504025 | Lynda Sue Baum | Clinical Nurse Specialist | 881 W State Rd Ste 140-429, Pleasant Grove, UT 84062-2131 | 2006-09-28 |
| 1053398610 | Connie Hall Strong | Clinical Nurse Specialist | 22 S State St, Clearfield, UT 84015-1043 | 2005-12-26 |
| 1356695175 | Mardi Bruner Bartholdt | Clinical Nurse Specialist | 1350 E 750 N, Orem, UT 84097-4345 | 2012-10-31 |
| 1144315110 | Joan L Hadley | Clinical Nurse Specialist | 5005 S 900 E, Suite 100, Murray, UT 84117-5788 | 2006-10-04 |
| City | SALT LAKE CITY |
| Zip Code | 84105 |
Please comment or provide details below to improve the information on MR. MARK DUDLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.