Healthcare Provider Details

I. General information

NPI: 1912411307
Provider Name (Legal Business Name): ALYSSA ANN DEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N 2260 W
HURRICANE UT
84737-2034
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-635-6500
  • Fax: 435-635-6549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6422358-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number6422358-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: