MARY JO RUSSELL Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000342

License Status

INACTIVE

Business

First Name

MARY JO

Last Name

RUSSELL

Business Name

MARY JO RUSSELL

Original Issue Date

12/15/1987

Effective Date

09/23/2014

Expiration Date

03/01/2016

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

03/24/2016