MEDICARE: LACEY MAE LAI PA-C

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	207N00000X	Dermatology Physician	14215824-1206	UT

General Provider Information

NPI Number	:	1225828866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY MAE LAI PA-C

Provider Business Mailing Address
First Line	:	783 W STEPHENS VIEW WAY
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8421
Country	:	US
Telephone Number	:	714-595-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E 4500 S STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-4057
Country	:	US
Telephone Number	:	385-533-8898
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

Similar Medicare Providers

1629591003 — EXEMPLAR HEALTHCARE, INC.
Practice Location Address:

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

Practice Phone: 801-433-0344
Practice Fax: 801-433-0075

1508355280 — ANDREA ELIZABETH MERKLEY APRN
Practice Location Address:

308 E 4500 S STE 100B
MURRAY, UT
84107-4057

Practice Phone: 385-533-8887
Practice Fax:

1164901484 — EXEMPLAR HEALTHCARE, INC.
Practice Location Address:

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

Practice Phone: 801-716-7800
Practice Fax: 866-676-6599

1164981932 — ARCHES HOME CARE, INC.
Practice Location Address:

308 E 4500 S STE 100A
MURRAY, UT
84107-4057

Practice Phone: 801-924-0950
Practice Fax:

1548922248 — MRS. MYKALA MIKESELL NELSON DNP, FNP-C, BSN, RN
Practice Location Address:

308 E 4500 S STE 100B
MURRAY, UT
84107-4057

Practice Phone: 801-900-3280
Practice Fax:

1336143361 — DR. WILLIAM HARMON TETTELBACH MD
Practice Location Address:

308 E 4500 S STE 100
SALT LAKE CITY, UT
84107-4057

Practice Phone: 385-533-8898
Practice Fax:

Directions to “ LACEY MAE LAI PA-C” 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.