Provider Demographics
NPI:1710562574
Name:PACE, BRANDI (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:T
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:312 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2961
Mailing Address - Country:US
Mailing Address - Phone:601-466-3353
Mailing Address - Fax:
Practice Address - Street 1:312 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2961
Practice Address - Country:US
Practice Address - Phone:601-466-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS338376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty