Provider Demographics
NPI:1457941023
Name:PACE, BONNIE S (MS, LDN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:PACE
Suffix:
Gender:F
Credentials:MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 CARAVAN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4046
Mailing Address - Country:US
Mailing Address - Phone:410-808-8082
Mailing Address - Fax:
Practice Address - Street 1:6838 CARAVAN CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4046
Practice Address - Country:US
Practice Address - Phone:410-808-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4173133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist