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General NPI Number Information
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NPI Number | 1295954097
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Entity Type | Individual
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Provider Name | MARTHA L BRAY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 630 SHEPARD LN
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City | FARMINGTON
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State | UT
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Zip | 84025-3934
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Country | US
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Telephone | 801-447-8680
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Fax | 801-447-4211
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Provider Business Mailing Address
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Address Line | 630 SHEPARD LN
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City | FARMINGTON
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State | UT
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Zip | 84025-3934
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Country | US
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Telephone | 801-447-8680
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Fax | 801-447-4211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number | 160926-4405
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License Number State | UT
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