Provider Demographics
NPI:1013253038
Name:SOULE, GENEVIEVE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ELIZABETH
Last Name:SOULE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:ELIZABETH
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST STE 200
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464
Practice Address - Country:US
Practice Address - Phone:616-748-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG06055020Medicare PIN