Individual provider · Type 1 NPI
Stacey Mills Lake, NP
Primary Care Nurse Practitioner · Holladay, UT
NPI number
1154003473
Active
Practice location
999 E Murray Holladay Rd Ste 207
Holladay, UT 84117-5093
Mailing address
2965 W 3500 S
West Valley City, UT 84119-3602
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5641317-4405 (UT) |
| Nurse Practitioner | 363L00000X | 5641317-4405 (UT) |
| Primary Care Nurse Practitioner Primary | 363LP2300X | 5641317-4405 (UT) |
Primary Care Nurse Practitioner: Definition to come...
3 other providers at this address
About NPI 1154003473
Stacey Mills Lake, NP's National Provider Identifier is 1154003473, issued on Aug 4, 2023. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Holladay, UT. The record was last updated on Jan 22, 2025.