BRIAN KEITH NORDGREN Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004284

License Status

INACTIVE

Business

First Name

BRIAN

Middle

KEITH

Last Name

NORDGREN

Business Name

BRIAN KEITH NORDGREN

Original Issue Date

02/22/2012

Effective Date

02/22/2012

Expiration Date

03/01/2014

City

NEWBERRY

State

Zip

32669

Ever Disciplined

LastModifiedDate

03/28/2014