Provider Demographics
NPI:1588617229
Name:NIGHTINGALE, MARTHA S (CNM, DNP)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:S
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:KAY
Other - Last Name:SAHUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1169 S 2000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1971
Mailing Address - Country:US
Mailing Address - Phone:801-971-2741
Mailing Address - Fax:
Practice Address - Street 1:5063 COTTONWOOD ST STE 130
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6772
Practice Address - Country:US
Practice Address - Phone:801-971-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3093788-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645904Medicaid
8855645Medicare ID - Type Unspecified
WA9645904Medicaid