JONATHAN E BOLLES Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003400

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

Last Name

BOLLES

Business Name

JONATHAN E BOLLES

Original Issue Date

12/19/2008

Effective Date

04/22/2020

Expiration Date

03/01/2022

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/27/2022