HEIDI JO DAHL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002337

License Status

NOT RENEWED

Business

First Name

HEIDI

Middle

Last Name

DAHL

Business Name

HEIDI JO DAHL

Original Issue Date

09/17/2004

Effective Date

09/17/2004

Expiration Date

03/01/2006

City

HOMER GLEN

State

Zip

60491

County

WILL

Ever Disciplined

LastModifiedDate

10/09/2006