DIANE RENEE COX Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004166

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

RENEE

Last Name

COX

Business Name

DIANE RENEE COX

Original Issue Date

09/28/2011

Effective Date

03/09/2018

Expiration Date

03/01/2020

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/24/2020