SHANNON MILLER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001664

License Status

NOT RENEWED

Business

First Name

SHANNON

Last Name

MILLER

Business Name

SHANNON MILLER

Original Issue Date

11/01/2001

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

POPLAR GROVE

State

Zip

61065

County

BOONE

Ever Disciplined

LastModifiedDate

07/27/2022