Individual
STACY PROBASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 N 1700 W, LAYTON, UT 84041-8803
(801) 773-4840
Mailing address
PO BOX 337, LAYTON, UT 84041-0337
(801) 773-4840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5542435-1206
UT
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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