DANIEL MARK PROVENCHER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001850

License Status

ACTIVE

Business

First Name

DANIEL

Middle

MARK

Last Name

PROVENCHER

Business Name

DANIEL MARK PROVENCHER

Original Issue Date

08/19/2002

Effective Date

12/09/2025

Expiration Date

03/01/2028

City

SAINT CHARLES

State

Zip

60174

County

KANE

Ever Disciplined

LastModifiedDate

12/09/2025