DIANNA CAROL MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005724

License Status

NOT RENEWED

Business

First Name

DIANNA

Middle

CAROL

Last Name

MARTIN

Business Name

DIANNA CAROL MARTIN

Original Issue Date

10/29/2015

Effective Date

02/25/2016

Expiration Date

03/01/2018

City

DUNLAP

State

Zip

61525

County

PEORIA

Ever Disciplined

LastModifiedDate

05/10/2018