KASSIA ROSE FORTUNA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006086

License Status

NOT RENEWED

Business

First Name

KASSIA

Middle

ROSE

Last Name

FORTUNA

Business Name

KASSIA ROSE FORTUNA

Original Issue Date

12/07/2016

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

LEBANON

State

Zip

62254

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

07/27/2022