Provider Demographics
NPI:1922313048
Name:PACE, FREDRIKA LYNETTE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:FREDRIKA
Middle Name:LYNETTE
Last Name:PACE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:FREDRIKA
Other - Middle Name:LYNETTE
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5831 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2042
Mailing Address - Country:US
Mailing Address - Phone:414-466-5840
Mailing Address - Fax:
Practice Address - Street 1:5831 N 60TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2042
Practice Address - Country:US
Practice Address - Phone:414-466-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305011031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse