KATHRYN DIANE TAILLIE - Physician Assistant License in Wisconsin | # 38*****51

KATHRYN DIANE TAILLIE

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****51

License Status

INOPERATIVE

Business

N

First Name

KATHRYN

Middle

DIANE

Last Name

TAILLIE

Business Name

KATHRYN DIANE TAILLIE

Original Issue Date

01/03/2017

Effective Date

12/10/2023

Expiration Date

03/01/2026

State

WI

Ever Disciplined

N

LastModifiedDate

12/03/2025