KRISTA DIANE NIEZWAAG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005134

License Status

NOT RENEWED

Business

First Name

KRISTA

Middle

DIANE

Last Name

NIEZWAAG

Business Name

KRISTA DIANE NIEZWAAG

Original Issue Date

08/08/2014

Effective Date

02/05/2020

Expiration Date

03/01/2022

City

BOISE

State

Zip

83709

County

KANE

Ever Disciplined

LastModifiedDate

07/27/2022