Provider Demographics
NPI:1619526670
Name:PACE-JOHNSTON, LORI ANN
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:PACE-JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BUSINESS
Mailing Address - Street 1:741 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2846
Mailing Address - Country:US
Mailing Address - Phone:614-266-3212
Mailing Address - Fax:614-252-1076
Practice Address - Street 1:741 BEDFORD AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2846
Practice Address - Country:US
Practice Address - Phone:614-266-3212
Practice Address - Fax:614-252-1076
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider