MEDICARE: MRS. LORI ANN PACE-JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider		OH

General Provider Information

NPI Number	:	1619526670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ANN PACE-JOHNSTON

Provider Business Mailing Address
First Line	:	741 BEDFORD AVENUE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2846
Country	:	US
Telephone Number	:	614-266-3212
Fax Number	:	614-252-1076

Provider Business Practice Location Address
First Line	:	741 BEDFORD AVENUE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2846
Country	:	US
Telephone Number	:	614-266-3212
Fax Number	:	614-252-1076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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