Provider Demographics
NPI:1033424742
Name:SOULE, KATHRYN ELEANOR (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELEANOR
Last Name:SOULE
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:EAST BUILDING RM MB540
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-626-4246
Mailing Address - Fax:612-624-7692
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:EAST BUILDING RM MB540
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-626-4246
Practice Address - Fax:612-624-7692
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2012-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant