MEDICARE: MS. THERESE BERNADETTE PACE CNS-BC

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	163WC1600X	Continuing Education/Staff Development Registered Nurse	NS-13404	OH
2	163WM0705X	Medical-Surgical Registered Nurse	RN-191022	OH

General Provider Information

NPI Number	:	1134558489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESE BERNADETTE PACE CNS-BC

Provider Business Mailing Address
First Line	:	3152 MEDINA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4221
Country	:	US
Telephone Number	:	614-236-7592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3152 MEDINA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4221
Country	:	US
Telephone Number	:	614-236-7592
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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