Individual
STACEY BANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4465 S 900 E, SUITE 200, SALT LAKE CITY, UT 84124-2456
(801) 266-2777
(801) 266-1377
Mailing address
4465 S 900 E, SUITE 200, SALT LAKE CITY, UT 84124-2456
(801) 266-2777
(801) 266-1377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5391997-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790797959
—
UT
Enumeration date
08/13/2006
Last updated
10/19/2021
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