MEDICARE: ACER LI

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	363A00000X	Physician Assistant	14179163-1206	UT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205571080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACER LI

Provider Business Mailing Address
First Line	:	2884 E BELTON CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-3861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2884 E BELTON CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-3861
Country	:	US
Telephone Number	:	801-696-8746
Fax Number	:

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

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	12/04/2025

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Directions to “ ACER LI ” Practice Location

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