LISA MARIE KIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003492

License Status

NOT RENEWED

Business

First Name

LISA

Middle

MARIE

Last Name

KIS

Business Name

LISA MARIE KIS

Original Issue Date

07/01/2009

Effective Date

02/17/2010

Expiration Date

03/01/2012

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/11/2012