MEDICARE: MARTHA SOFIA HORTON R.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	185714	AZ

General Provider Information

NPI Number	:	1023484482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA SOFIA HORTON R.N

Provider Business Mailing Address
First Line	:	6815 S MCCLINTOCK DR
Second Line	:	1130
City	:	TEMPE
State	:	AZ
Zip	:	85283-5701
Country	:	US
Telephone Number	:	480-289-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	13612 S 36TH ST
Second Line	:	APT. #1065
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4544
Country	:	US
Telephone Number	:	480-541-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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