Healthcare Provider Details

I. General information

NPI: 1891456141
Provider Name (Legal Business Name): WHITNEY P MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S 200 E STE B
SALT LAKE CITY UT
84111-3802
US

IV. Provider business mailing address

1947 OLD FORT RD
FARMINGTON UT
84025-2644
US

V. Phone/Fax

Practice location:
  • Phone: 801-539-8617
  • Fax:
Mailing address:
  • Phone: 801-573-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number8317256-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8317256-4402
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8317256-4404
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: