Healthcare Provider Details

I. General information

NPI: 1134558489
Provider Name (Legal Business Name): THERESE BERNADETTE PACE CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 MEDINA AVE
COLUMBUS OH
43224-4221
US

IV. Provider business mailing address

3152 MEDINA AVE
COLUMBUS OH
43224-4221
US

V. Phone/Fax

Practice location:
  • Phone: 614-236-7592
  • Fax:
Mailing address:
  • Phone: 614-236-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberNS-13404
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN-191022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: