Provider Demographics
NPI:1891456141
Name:MARTINEZ, WHITNEY P (RN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:P
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 OLD FORT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2644
Mailing Address - Country:US
Mailing Address - Phone:801-573-7920
Mailing Address - Fax:
Practice Address - Street 1:610 S 200 E STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3802
Practice Address - Country:US
Practice Address - Phone:801-539-8617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8317256-3102163WM0102X
UT8317256-4402367A00000X
UT8317256-4404367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8317256-3102OtherUTAH DEPARTMENT OF COMMERCE- DOPL
UT8317256-4402OtherUTAH DEPARTMENT OF COMMERCE- DOPL