Individual
SAMANTHA LEE STACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
Mailing address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10932001-4405
UT
363LF0000X
Family Nurse Practitioner
Primary
10932001-4405
UT
Other
Enumeration date
02/14/2019
Last updated
12/10/2024
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