Individual
FERN MARTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1169 E 1010 N, SPANISH FORK, UT 84660-5507
(801) 851-7661
Mailing address
724 W 1720 N, #211, PROVO, UT 84604-2486
(801) 494-1070
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/22/2013
Last updated
04/22/2013
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