Provider Demographics
NPI:1811290943
Name:PACE, ELLEN ROSE (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ROSE
Last Name:PACE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:R AUSTERMANN
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:4116 VON TALGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1957
Mailing Address - Country:US
Mailing Address - Phone:314-892-8787
Mailing Address - Fax:314-892-8790
Practice Address - Street 1:4116 VON TALGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1957
Practice Address - Country:US
Practice Address - Phone:314-892-8787
Practice Address - Fax:314-892-8790
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008768363LA2200X
MI4704387291363LA2200X
IL209008864363LA2200X
MO2010037013363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010001621OtherANP-BC