Provider Demographics
NPI:1023484482
Name:HORTON, MARTHA SOFIA (RN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:SOFIA
Last Name:HORTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 S MCCLINTOCK DR
Mailing Address - Street 2:1130
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5701
Mailing Address - Country:US
Mailing Address - Phone:480-289-1120
Mailing Address - Fax:
Practice Address - Street 1:13612 S 36TH ST
Practice Address - Street 2:APT. #1065
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4544
Practice Address - Country:US
Practice Address - Phone:480-541-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ185714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse