ELLEN R BLOOD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001717

License Status

NOT RENEWED

Business

First Name

ELLEN

Middle

Last Name

BLOOD

Business Name

ELLEN R BLOOD

Original Issue Date

11/20/2001

Effective Date

12/17/2018

Expiration Date

03/01/2020

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/24/2020