Healthcare Provider Details

I. General information

NPI: 1497163489
Provider Name (Legal Business Name): HEATHER MARTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 N PEART RD STE 20
CASA GRANDE AZ
85122-2497
US

IV. Provider business mailing address

2051 W CHANDLER BLVD STE 5
CHANDLER AZ
85224-6239
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9000
  • Fax: 480-214-9999
Mailing address:
  • Phone: 480-214-9000
  • Fax: 480-214-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number266780
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266780
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN168783
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: