MEDICARE: MS. NICOLE MARIE JOHNSON SC.M, CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1336138205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MARIE JOHNSON SC.M, CGC

Provider Business Mailing Address
First Line	:	200 N. MAPLE AVE
Second Line	:	UNIT #203
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046
Country	:	US
Telephone Number	:	443-768-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 BRANNAN ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-5418
Country	:	US
Telephone Number	:	443-768-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	06/02/2016

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