Individual
LAURA J BOLENZ-GEESIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503
(616) 391-1680
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003165
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00397293
RAILROAD MEDICARE
MI
Enumeration date
09/13/2005
Last updated
08/06/2018
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