MEDICARE: MARY E MARTIN DEM

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	176B00000X	Midwife		UT

General Provider Information

NPI Number	:	1164120077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E MARTIN DEM

Provider Business Mailing Address
First Line	:	983 E WADDELL ST
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-4598
Country	:	US
Telephone Number	:	801-416-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	983 E WADDELL ST
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-4598
Country	:	US
Telephone Number	:	801-416-3602
Fax Number	:

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

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	04/10/2026

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Directions to “ MARY E MARTIN DEM” Practice Location

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