Provider Demographics
NPI:1144984220
Name:DEWEY, MARK JAMES (NP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:DEWEY
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E 1060 S
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6250
Mailing Address - Country:US
Mailing Address - Phone:435-229-6333
Mailing Address - Fax:
Practice Address - Street 1:316 E 1060 S
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6250
Practice Address - Country:US
Practice Address - Phone:435-229-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF10210417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily