Provider Demographics
NPI:1821596701
Name:BARTLETT, ROBERT DEAN (DNP, AGACNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:DNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 S SAGE VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-3955
Mailing Address - Country:US
Mailing Address - Phone:801-879-7064
Mailing Address - Fax:
Practice Address - Street 1:8TH AVE & C STREET
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-3617
Practice Address - Fax:801-408-5110
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7986302-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care