Provider Demographics
NPI:1639834898
Name:MACE, BURNICE L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BURNICE
Middle Name:L
Last Name:MACE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1602
Mailing Address - Country:US
Mailing Address - Phone:240-362-7025
Mailing Address - Fax:240-362-7571
Practice Address - Street 1:921 SETON DR STE F&G
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1852
Practice Address - Country:US
Practice Address - Phone:240-522-0098
Practice Address - Fax:240-522-0099
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily