MEDICARE: DR. MARTHA S NIGHTINGALE CNM, DNP

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	367A00000X	Advanced Practice Midwife	3093788-4402	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588617229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA S NIGHTINGALE CNM, DNP

Provider Business Mailing Address
First Line	:	1169 S 2000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1971
Country	:	US
Telephone Number	:	801-971-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5063 COTTONWOOD ST STE 130
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6772
Country	:	US
Telephone Number	:	801-971-2741
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/13/2013

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