TAYLOR MARIE MANIVANNAN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005629

License Status

ACTIVE

Business

First Name

TAYLOR

Middle

MARIE

Last Name

MANIVANNAN

Business Name

TAYLOR MARIE MANIVANNAN

Original Issue Date

09/11/2015

Effective Date

12/29/2025

Expiration Date

03/01/2028

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/29/2025