Healthcare Provider Details

I. General information

NPI: 1730227281
Provider Name (Legal Business Name): EDNA PEARL MACE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S MAPLE ST
LANCASTER OH
43130-4843
US

IV. Provider business mailing address

267 ADAMS ST
NELSONVILLE OH
45764-1057
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-9931
  • Fax:
Mailing address:
  • Phone: 740-753-4664
  • Fax: 740-753-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN 208032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: