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General NPI Number Information
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NPI Number | 1225828866
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Entity Type | Individual
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Provider Name | LACEY MAE LAI PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 308 E 4500 S STE 100
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City | MURRAY
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State | UT
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Zip | 84107-4057
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Country | US
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Telephone | 385-533-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 783 W STEPHENS VIEW WAY
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City | DRAPER
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State | UT
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Zip | 84020-8421
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Country | US
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Telephone | 714-595-2008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 14215824-1206
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License Number State | UT
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