MARIAH MARIE WAGNER - Physician Assistant License in Illinois | # 085007649

MARIAH MARIE WAGNER

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007649

License Status

ACTIVE

Business

N

First Name

MARIAH

Middle

MARIE

Last Name

WAGNER

Business Name

MARIAH MARIE WAGNER

Original Issue Date

05/12/2020

Effective Date

01/06/2026

Expiration Date

03/01/2028

State

IL

Ever Disciplined

N

LastModifiedDate

01/06/2026