Provider Demographics
NPI:1366585242
Name:VERDUIN, ELIZABETH M (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:VERDUIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:705 S GREENVILLE WEST DR STE 102
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3556
Practice Address - Country:US
Practice Address - Phone:616-225-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002878363A00000X
MILV002878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant