MEDICARE: AUTUMN VARA MS

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	:	1023616182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN VARA MS

Provider Business Mailing Address
First Line	:	15418 GETTYSBURG DR
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77377-8607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5143
Country	:	US
Telephone Number	:	713-745-7391
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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