Individual
STACIE GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
395 W COUGAR BLVD STE 602, PROVO, UT 84604-3331
(801) 357-0570
Mailing address
395 W COUGAR BLVD STE 602, PROVO, UT 84604-3331
(801) 357-0570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/07/2023
Last updated
06/07/2023
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