JENNIFER BROOKE RUSSELL - Physician Assistant License in New York | # 085004452

JENNIFER BROOKE RUSSELL

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004452

License Status

NOT RENEWED

Business

N

First Name

JENNIFER

Middle

BROOKE

Last Name

RUSSELL

Business Name

JENNIFER BROOKE RUSSELL

Original Issue Date

09/17/2012

Effective Date

09/17/2012

Expiration Date

03/01/2014

State

NY

Ever Disciplined

N

LastModifiedDate

04/08/2014