Healthcare Provider Details

I. General information

NPI: 1225828866
Provider Name (Legal Business Name): LACEY MAE LAI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 4500 S STE 100
MURRAY UT
84107-4057
US

IV. Provider business mailing address

783 W STEPHENS VIEW WAY
DRAPER UT
84020-8421
US

V. Phone/Fax

Practice location:
  • Phone: 385-533-8898
  • Fax:
Mailing address:
  • Phone: 714-595-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14215824-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: