KASEY L PONTARELLI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005706

License Status

NOT RENEWED

Business

First Name

KASEY

Middle

Last Name

PONTARELLI

Business Name

KASEY L PONTARELLI

Original Issue Date

10/09/2015

Effective Date

02/25/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/05/2025