Provider Demographics
NPI:1568619575
Name:PACE, DEBORAH LYNN
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:LYNN
Last Name:PACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9677 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-9749
Mailing Address - Country:US
Mailing Address - Phone:269-795-3132
Mailing Address - Fax:269-673-6495
Practice Address - Street 1:9677 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:DELTON
Practice Address - State:MI
Practice Address - Zip Code:49046-9749
Practice Address - Country:US
Practice Address - Phone:269-795-3132
Practice Address - Fax:269-673-6495
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker