AMBER D LUTZ Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002198

License Status

NOT RENEWED

Business

First Name

AMBER

Middle

Last Name

LUTZ

Business Name

AMBER D LUTZ

Original Issue Date

12/16/2003

Effective Date

02/23/2012

Expiration Date

03/01/2014

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Ever Disciplined

LastModifiedDate

01/08/2015