AMY MARIE BOLT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003100

License Status

NOT RENEWED

Business

First Name

AMY

Middle

MARIE

Last Name

BOLT

Business Name

AMY MARIE BOLT

Original Issue Date

10/11/2007

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

WHEATON

State

Zip

60187

County

DUPAGE

Ever Disciplined

LastModifiedDate

09/22/2010