JENNIFER BLASE BRADLEY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002534

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

BLASE

Last Name

BRADLEY

Business Name

JENNIFER BLASE BRADLEY

Original Issue Date

08/15/2005

Effective Date

12/09/2009

Expiration Date

03/01/2012

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/11/2012