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NPI Code Detail

MEDICARE: NICOLE GOSTIC MS

MEDICARE: NICOLE GOSTIC 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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1063143808
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GOSTIC MS
Provider Business Mailing Address
First Line : 1804 LAKESHORE CT
Second Line :
City : MCKINNEY
State : TX
Zip : 75072-4021
Country : US
Telephone Number : 972-832-9556
Fax Number :
Provider Business Practice Location Address
First Line : 3410 WORTH ST STE 200
Second Line :
City : DALLAS
State : TX
Zip : 75246-2008
Country : US
Telephone Number : 214-818-9571
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2022
Last Update Date : 06/22/2022

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Directions to “ NICOLE GOSTIC MS” Practice Location

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