Healthcare Provider Details

I. General information

NPI: 1548598899
Provider Name (Legal Business Name): BRIEN RAYMOND PACE ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 CROUSE LN
BURLINGTON NC
27215-9480
US

IV. Provider business mailing address

508 FULTON ST
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-4200
  • Fax:
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-416-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number220326
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004575
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: