JOLENA MARIE MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002607

License Status

NOT RENEWED

Business

First Name

JOLENA

Middle

MARIE

Last Name

MARTIN

Business Name

JOLENA MARIE MARTIN

Original Issue Date

10/03/2005

Effective Date

03/13/2018

Expiration Date

03/01/2020

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

11/24/2020