Healthcare Provider Details

I. General information

NPI: 1558510123
Provider Name (Legal Business Name): KRISTINE E. MARTIN RN, MSN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 E 900 N
SPANISH FORK UT
84660-1232
US

IV. Provider business mailing address

957 N 920 W
OREM UT
84057-7708
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-1054
  • Fax:
Mailing address:
  • Phone: 801-473-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number220671-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: