Provider Demographics
NPI:1902313679
Name:PACE, LAKETHA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAKETHA
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 NEWBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-8652
Mailing Address - Country:US
Mailing Address - Phone:803-317-9312
Mailing Address - Fax:
Practice Address - Street 1:1406 NEWBERRY HWY
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-8652
Practice Address - Country:US
Practice Address - Phone:803-317-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP46341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12271978OtherBIRTHDATE