Individual
MARTHA FERN SOUTHWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8541 S REDWOOD RD STE C2, WEST JORDAN, UT 84088
(801) 432-7712
(866) 817-1629
Mailing address
1947 KATE CV, WEST JORDAN, UT 84088-6631
(801) 561-2280
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2000204405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017129
—
UT
Enumeration date
04/10/2007
Last updated
06/06/2018
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