RENATA B PTAK - Physician Assistant License in Wisconsin | # 085003716

RENATA B PTAK

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003716

License Status

INACTIVE

Business

N

First Name

RENATA

Middle

B

Last Name

PTAK

Business Name

RENATA B PTAK

Original Issue Date

03/31/2010

Effective Date

03/31/2010

Expiration Date

03/01/2012

State

WI

Ever Disciplined

N

LastModifiedDate

12/07/2011