MEDICARE: STACEY MILLS LAKE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5641317-4405	UT
2	363L00000X	Nurse Practitioner	5641317-4405	UT
3	363LP2300X	Primary Care Nurse Practitioner	5641317-4405	UT

General Provider Information

NPI Number	:	1154003473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY MILLS LAKE NP

Provider Business Mailing Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 E MURRAY HOLLADAY RD STE 207
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-5093
Country	:	US
Telephone Number	:	801-268-2584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	01/22/2025

Similar Medicare Providers

1205820693 — DR. RICHARD B GREMILLION MD
Practice Location Address:

999 E MURRAY HOLLADAY RD STE 207
MILLCREEK, UT
84117-5093

Practice Phone: 801-965-3600
Practice Fax:

1609037779 — DR. BRUCE A. PYPER DMD
Practice Location Address:

999 E MURRAY HOLLADAY RD STE 205
SALT LAKE CITY, UT
84117-5093

Practice Phone: 801-277-8233
Practice Fax:

1588043871 — DR. JORDAN RUSSELL ROBERTS M.D.
Practice Location Address:

999 E MURRAY HOLLADAY RD STE 207
HOLLADAY, UT
84117-5093

Practice Phone: 801-268-2584
Practice Fax: 801-262-1168

1558941583 — JOSHUA R LLOYD DO
Practice Location Address:

999 E MURRAY HOLLADAY RD STE 207
MILLCREEK, UT
84117-5093

Practice Phone: 801-965-3600
Practice Fax:

1144153172 — UPLIFT FOR HER, LLC
Practice Location Address:

4685 S HIGHLAND DR STE 208
HOLLADAY, UT
84117-5163

Practice Phone: 385-401-2895
Practice Fax: 385-429-1632

1982864690 — MALLORIE J. CRACROFT MD
Practice Location Address:

4685 S HIGHLAND DR STE 208
HOLLADAY, UT
84117-5163

Practice Phone: 385-401-2895
Practice Fax: 385-429-1632

Directions to “ STACEY MILLS LAKE NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.