Provider Demographics
NPI:1962024604
Name:PACE, JASMINE MONIQUE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONIQUE
Last Name:PACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 RUBLE CT
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-1316
Mailing Address - Country:US
Mailing Address - Phone:216-287-7890
Mailing Address - Fax:
Practice Address - Street 1:5151 RUBLE CT
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-1316
Practice Address - Country:US
Practice Address - Phone:216-287-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170429164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse