Provider Demographics
NPI:1891901138
Name:MARTIN, JENNA LEA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0811
Mailing Address - Country:US
Mailing Address - Phone:801-394-3699
Mailing Address - Fax:
Practice Address - Street 1:2250 ROBINS DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-773-7060
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other