LISA A GROOMS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000546

License Status

NOT RENEWED

Business

First Name

LISA A

Last Name

GROOMS

Business Name

LISA A GROOMS

Original Issue Date

08/03/1993

Effective Date

08/03/1993

Expiration Date

03/01/1998

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/26/2006