WHITNEY MARIE LATHAM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003799

License Status

NOT RENEWED

Business

First Name

WHITNEY

Middle

MARIE

Last Name

LATHAM

Business Name

WHITNEY MARIE LATHAM

Original Issue Date

07/15/2010

Effective Date

01/04/2012

Expiration Date

03/01/2014

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/08/2014