THERESA M FAIRBANK - Physician Assistant License in Tennessee | # 085002912

THERESA M FAIRBANK

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002912

License Status

NOT RENEWED

Business

N

First Name

THERESA

Middle

M

Last Name

FAIRBANK

Business Name

THERESA M FAIRBANK

Original Issue Date

12/11/2006

Effective Date

12/11/2006

Expiration Date

03/01/2008

State

TN

Ever Disciplined

N

LastModifiedDate

04/23/2008