Provider Demographics
NPI:1558510123
Name:MARTIN, KRISTINE E (RN, MSN, APN)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 N 920 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7708
Mailing Address - Country:US
Mailing Address - Phone:801-473-1030
Mailing Address - Fax:
Practice Address - Street 1:78 E 900 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1232
Practice Address - Country:US
Practice Address - Phone:801-794-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT220671-4405261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000531Medicare PIN