KATIE MARIE DIENELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006341

License Status

NOT RENEWED

Business

First Name

KATIE

Middle

MARIE

Last Name

DIENELL

Business Name

KATIE MARIE DIENELL

Original Issue Date

09/07/2017

Effective Date

02/27/2018

Expiration Date

03/01/2020

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

11/24/2020