RYAN FERREL MANSHOLT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002874

License Status

NOT RENEWED

Business

First Name

RYAN

Middle

FERREL

Last Name

MANSHOLT

Business Name

RYAN FERREL MANSHOLT

Original Issue Date

10/31/2006

Effective Date

01/25/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

08/08/2016