Provider Demographics
NPI:1962516526
Name:BARLOW, MARTHA (APN, CNM)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BARLOW
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NORTH HILDALE ST.
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-0459
Mailing Address - Country:US
Mailing Address - Phone:435-874-2217
Mailing Address - Fax:435-874-7805
Practice Address - Street 1:1065 NORTH HILDALE ST.
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-0459
Practice Address - Country:US
Practice Address - Phone:435-874-2217
Practice Address - Fax:435-874-7805
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN055020363L00000X
UT213305-4402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ169145OtherAHCCCS
UT000071001Medicare ID - Type Unspecified
AZ169145OtherAHCCCS