Basic Information
| Provider Information | |||||||||
| NPI: | 1891456141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1947 OLD FORT RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840252644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015737920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 S 200 E STE B | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841113802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015398617 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2022 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0102X | 8317256-3102 | UT | N | Nursing Service Providers | Registered Nurse | Maternal Newborn | 367A00000X | 8317256-4402 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 8317256-4404 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 8317256-3102 | 01 | UT | UTAH DEPARTMENT OF COMMERCE- DOPL | OTHER | 8317256-4402 | 01 | UT | UTAH DEPARTMENT OF COMMERCE- DOPL | OTHER |