Provider Demographics
NPI:1760143713
Name:PACE, PETER EMANUEL (RD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EMANUEL
Last Name:PACE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3315
Mailing Address - Country:US
Mailing Address - Phone:914-804-5668
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-5171
Practice Address - Country:US
Practice Address - Phone:914-804-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86091582133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered