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General NPI Number Information
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NPI Number | 1568685550
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Entity Type | Individual
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Provider Name | MARTHA FERN SOUTHWICK NP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 8541 S REDWOOD RD STE C2
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City | WEST JORDAN
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State | UT
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Zip | 84088
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Country | US
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Telephone | 801-432-7712
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Fax | 866-817-1629
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Provider Business Mailing Address
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Address Line | 1947 KATE CV
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City | WEST JORDAN
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State | UT
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Zip | 84088-6631
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Country | US
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Telephone | 801-561-2280
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2000204405
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License Number State | UT
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