Provider Demographics
NPI:1164288353
Name:PACE, COURTNEY (IBCLC, MS, LMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:IBCLC, MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1206
Mailing Address - Country:US
Mailing Address - Phone:775-338-6024
Mailing Address - Fax:
Practice Address - Street 1:1775 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1206
Practice Address - Country:US
Practice Address - Phone:775-338-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-164973174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN