Provider Demographics
NPI:1578706248
Name:GROFF, GENEVIEVE H (PA)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:H
Last Name:GROFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5030 S MILL AVE
Mailing Address - Street 2:SUITE D12
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6833
Mailing Address - Country:US
Mailing Address - Phone:480-894-2823
Mailing Address - Fax:480-756-6663
Practice Address - Street 1:5030 S MILL AVE
Practice Address - Street 2:SUITE D12
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6833
Practice Address - Country:US
Practice Address - Phone:480-894-2823
Practice Address - Fax:480-756-6663
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480044Medicaid