Individual
MS. STACEY M DORAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
201 S 1460 E RM 426, SALT LAKE CITY, UT 84112-9061
(801) 581-6826
(801) 585-6816
Mailing address
201 S 1460 E RM 426, SALT LAKE CITY, UT 84112-9061
(801) 581-6826
(801) 585-6816
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
92358484405
UT
Other
Enumeration date
09/19/2013
Last updated
10/01/2020
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