Healthcare Provider Details

I. General information

NPI: 1598583981
Provider Name (Legal Business Name): MARTHA DOSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 PADDINGTON DR
PARK CITY UT
84060-7434
US

IV. Provider business mailing address

2014 PADDINGTON DR
PARK CITY UT
84060-7434
US

V. Phone/Fax

Practice location:
  • Phone: 210-279-8247
  • Fax:
Mailing address:
  • Phone: 210-279-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number10771220-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: