Provider Demographics
NPI:1043990492
Name:PACE, STEPHANIE SAMAR (CRNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SAMAR
Last Name:PACE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MANUEL
Other - Last Name:SAMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:146 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1531
Mailing Address - Country:US
Mailing Address - Phone:858-204-0246
Mailing Address - Fax:
Practice Address - Street 1:2311 COTTMAN AVE STE 71
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1007
Practice Address - Country:US
Practice Address - Phone:484-612-7294
Practice Address - Fax:215-695-2919
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027943363LF0000X
PARN643391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse