Individual
STACEY MILLS LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
999 E MURRAY HOLLADAY RD STE 207, HOLLADAY, UT 84117-5093
(801) 268-2584
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5641317-4405
UT
363LF0000X
Family Nurse Practitioner
5641317-4405
UT
363LP2300X
Primary Care Nurse Practitioner
Primary
5641317-4405
UT
Other
Enumeration date
08/04/2023
Last updated
01/22/2025
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