Healthcare Provider Details

I. General information

NPI: 1801708151
Provider Name (Legal Business Name): GARISON J MARTIN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 E GOLDLINE DR
WASHINGTON UT
84780-2585
US

IV. Provider business mailing address

567 E GOLDLINE DR
WASHINGTON UT
84780-2585
US

V. Phone/Fax

Practice location:
  • Phone: 801-735-4101
  • Fax:
Mailing address:
  • Phone: 801-735-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13181539-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: