Provider Demographics
NPI:1407226269
Name:MCGUFFIN, MARTHA (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCGUFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9879
Mailing Address - Fax:928-522-9880
Practice Address - Street 1:488 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5103
Practice Address - Country:US
Practice Address - Phone:928-333-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily