MARYANN BERTUSO Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001116

License Status

NOT RENEWED

Business

First Name

MARYANN

Last Name

BERTUSO

Business Name

MARYANN BERTUSO

Original Issue Date

01/11/1999

Effective Date

03/11/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/05/2025