Healthcare Provider Details

I. General information

NPI: 1407226269
Provider Name (Legal Business Name): MARTHA MCGUFFIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 S MOUNTAIN AVE
SPRINGERVILLE AZ
85938-5103
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-0127
  • Fax:
Mailing address:
  • Phone: 928-522-9879
  • Fax: 928-522-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10762
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: