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General NPI Number Information
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NPI Number | 1043990492
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Entity Type | Individual
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Provider Name | STEPHANIE SAMAR PACE CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 2311 COTTMAN AVE STE 71
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1007
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Country | US
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Telephone | 484-612-7294
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Fax | 215-695-2919
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Provider Business Mailing Address
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Address Line | 146 GREENWOOD AVE
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City | WYNCOTE
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State | PA
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Zip | 19095-1531
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Country | US
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Telephone | 858-204-0246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP027943
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN643391
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License Number State | PA
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