MARY L BRANDENBURG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001021

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

BRANDENBURG

Business Name

MARY L BRANDENBURG

Original Issue Date

01/30/1998

Effective Date

07/06/2018

Expiration Date

03/01/2020

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Ever Disciplined

LastModifiedDate

11/24/2020