Healthcare Provider Details

I. General information

NPI: 1407927767
Provider Name (Legal Business Name): KRISTA H MARTIN W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 N WYATT DR STE. 260
TUCSON AZ
85712-6115
US

IV. Provider business mailing address

2424 N WYATT DR STE. 260
TUCSON AZ
85712-6115
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-8080
  • Fax: 520-323-6237
Mailing address:
  • Phone: 520-795-0549
  • Fax: 520-795-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN032225
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: