Provider Demographics
NPI:1770876625
Name:PACE, MELISSA ANNE (NP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:PACE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2268
Mailing Address - Country:US
Mailing Address - Phone:208-452-7450
Mailing Address - Fax:208-452-7550
Practice Address - Street 1:811 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2268
Practice Address - Country:US
Practice Address - Phone:208-452-7450
Practice Address - Fax:208-452-7550
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1048A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily