AUDRA JANESE DUST Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005515

License Status

NOT RENEWED

Business

First Name

AUDRA

Middle

JANESE

Last Name

DUST

Business Name

AUDRA JANESE DUST

Original Issue Date

06/30/2015

Effective Date

03/01/2018

Expiration Date

03/01/2020

City

SULLIVAN

State

Zip

61951

County

MOULTRIE

Ever Disciplined

LastModifiedDate

11/24/2020