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General NPI Number Information
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NPI Number | 1619623360
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Entity Type | Individual
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Provider Name | MIRANDA LYNN COX MS, CGC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 8201 E RIVERSIDE BLVD PHYSICIAN CLINIC, FLOOR 2
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-5069
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Fax | 815-968-7830
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Provider Business Mailing Address
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Address Line | 8201 E RIVERSIDE BLVD PHYSICIAN CLINIC, FLOOR 2
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-5069
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Fax | 815-968-7830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 247.000153
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License Number State | IL
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