Healthcare Provider Details

I. General information

NPI: 1083802326
Provider Name (Legal Business Name): HOLLI DEE MARTINEZ APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US

IV. Provider business mailing address

PO BOX 413033
SALT LAKE CITY UT
84141-3033
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7818
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346220-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: