Provider Demographics
NPI:1497271464
Name:PACE, DONNA M (MBA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:PACE
Suffix:
Gender:F
Credentials:MBA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NURSERY AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2321
Mailing Address - Country:US
Mailing Address - Phone:504-258-0904
Mailing Address - Fax:
Practice Address - Street 1:214 MACK LN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9547
Practice Address - Country:US
Practice Address - Phone:985-264-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA431133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1255712410Medicaid