1811290943 NPI number — MRS. ELLEN ROSE PACE ANP-BC

Table of content: MRS. ELLEN ROSE PACE ANP-BC (NPI 1811290943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811290943 NPI number — MRS. ELLEN ROSE PACE ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACE
Provider First Name:
ELLEN
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PACE
Provider Other First Name:
ELLEN
Provider Other Middle Name:
R AUSTERMANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811290943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4116 VON TALGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-892-8787
Provider Business Mailing Address Fax Number:
314-892-8790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4116 VON TALGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-892-8787
Provider Business Practice Location Address Fax Number:
314-892-8790
Provider Enumeration Date:
12/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  APRN11008768 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 4704387291 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 209008864 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 2010037013 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2010001621 . This is a "ANP-BC" identifier . This identifiers is of the category "OTHER".