Healthcare Provider Details

I. General information

NPI: 1851799217
Provider Name (Legal Business Name): MICHELLE LYNN PACE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3130
US

IV. Provider business mailing address

4095 WESTMEADOW DR APT 1211
COLORADO SPRINGS CO
80906-6072
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-7000
  • Fax:
Mailing address:
  • Phone: 719-493-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1618792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: