Basic Information
| Provider Information | |||||||||
| NPI: | 1568607422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACE | ||||||||
| FirstName: | HAGAN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 S. VAN BUREN RD. | ||||||||
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| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366274391 | ||||||||
| FaxNumber: | 3366275502 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 S. VAN BUREN RD. | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366274391 | ||||||||
| FaxNumber: | 3366275502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2008 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5004192 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207V00000X | 5004192 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.