Mrs Shirley Jean Bleak, FNP-C, MSN, RNC in Salt Lake City, UT

Mrs Shirley Jean Bleak, FNP-C, MSN, RNC is a medicare enrolled "Nurse Practitioner - Family" in Salt Lake City, Utah. She graduated from nursing school in 1998 and has 26 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Utah Cancer Specialists Pc and her current practice location is 5131 Cottonwood St, L-2, Salt Lake City, Utah. You can reach out to her office (for appointments etc.) via phone at (801) 263-3415.

Mrs Shirley Jean Bleak is licensed to practice in Utah (license number 193402-4405) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1124197512.

Contact Information

	Mrs Shirley Jean Bleak, FNP-C, MSN, RNC
	5131 Cottonwood St, L-2, Salt Lake City, UT 84107-5701
	(801) 263-3415
	(801) 263-3428

Map and Direction

Provider's Profile

Full Name	Mrs Shirley Jean Bleak
Gender	Female
Speciality	Nurse Practitioner
Experience	26 Years
Location	5131 Cottonwood St, Salt Lake City, Utah
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mrs Shirley Jean Bleak graduated from nursing school in 1998

NPI Data:

NPI Number: 1124197512
Provider Enumeration Date: 11/07/2006
Last Update Date: 01/15/2019

Medicare PECOS Information:

PECOS PAC ID: 1850476789
Enrollment ID: I20080317000350

Medical Identifiers

Medical identifiers for Mrs Shirley Jean Bleak such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1124197512	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	193402-4405 (Utah)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Utah Cancer Specialists Pc	1355254749	44

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Shirley Jean Bleak allows following entities to bill medicare on her behalf.

Entity Name	Utah Cancer Specialists Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1619925369 PECOS PAC ID: 1355254749 Enrollment ID: O20031111000618

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Shirley Jean Bleak is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Shirley Jean Bleak, FNP-C, MSN, RNC 1121 E 3900 S, Suite C-230, Salt Lake City, UT 84124-1214 Ph: (801) 262-9494	Mrs Shirley Jean Bleak, FNP-C, MSN, RNC 5131 Cottonwood St, L-2, Salt Lake City, UT 84107-5701 Ph: (801) 263-3415

Reviews and Comments

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Mrs Shirley Jean Bleak, FNP-C, MSN, RNC - Medicare Nurse Practitioner in Salt Lake City, UT