MARIE ANNETTE HERZOG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005540

License Status

NOT RENEWED

Business

First Name

MARIE

Middle

ANNETTE

Last Name

HERZOG

Business Name

MARIE ANNETTE HERZOG

Original Issue Date

07/10/2015

Effective Date

02/10/2016

Expiration Date

03/01/2018

City

PEORIA

State

Zip

61603

County

PEORIA

Ever Disciplined

LastModifiedDate

05/10/2018