Individual
MICAH LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 N MARIO CAPECCHI DR, SLC, UT 84113-1103
(801) 662-4000
Mailing address
1584 HARVARD AVE, SALT LAKE CITY, UT 84105-1726
(406) 671-2272
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8110172-1206
UT
Other
Enumeration date
10/05/2011
Last updated
08/06/2015
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