Provider Demographics
NPI:1871603860
Name:DEAN, SHERLENE CLARK (APRN)
Entity type:Individual
Prefix:MS
First Name:SHERLENE
Middle Name:CLARK
Last Name:DEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 413076
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3076
Mailing Address - Country:US
Mailing Address - Phone:801-213-3900
Mailing Address - Fax:801-585-3655
Practice Address - Street 1:650 S KOMAS DR STE 208
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1241
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:801-585-9096
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT204333-4405364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005529528Medicare ID - Type Unspecified