IndividualActive
Stacey Lake, NP
NPI 1154003473 · Primary Care Nurse Practitioner · Holladay, UT
Provider details
- NPI number
- 1154003473
- Entity type
- Individual
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- License
- 5641317-4405 (UT)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
999 E Murray Holladay Rd Ste 207
Holladay, UT 84117-5093
Phone: (801) 268-2584
Approximate (ZIP-level) locationGet directions
Mailing address
2965 W 3500 S
West Valley City, UT 84119-3602
Registry dates
- Enumerated
- 2023-08-04
- Last updated
- 2025-01-22
- Certified
- 2025-01-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.