Provider Demographics
NPI:1154466092
Name:UTLEY, MARTHA ELLEN (HS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELLEN
Last Name:UTLEY
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1807
Mailing Address - Country:US
Mailing Address - Phone:907-463-2146
Mailing Address - Fax:907-463-2150
Practice Address - Street 1:709 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1807
Practice Address - Country:US
Practice Address - Phone:907-463-2146
Practice Address - Fax:907-463-2150
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other