MEDICARE: MRS. STEPHANIE ROBBINS NIX M.S, 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	:	1780669069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ROBBINS NIX M.S, CGC

Provider Business Mailing Address
First Line	:	3483 NESTLING LN
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7835
Country	:	US
Telephone Number	:	803-547-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL ST
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2839
Country	:	US
Telephone Number	:	704-355-6089
Fax Number	:

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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