MARY K LANE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000746

License Status

NOT RENEWED

Business

First Name

MARY K

Last Name

LANE

Business Name

MARY K LANE

Original Issue Date

02/06/1996

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

GLEN CARBON

State

Zip

62034

County

MADISON

Ever Disciplined

LastModifiedDate

04/01/2010