SHANNON ROOT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007847

License Status

NOT RENEWED

Business

First Name

SHANNON

Last Name

ROOT

Business Name

SHANNON ROOT

Original Issue Date

07/20/2020

Effective Date

07/20/2020

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61615

Ever Disciplined

LastModifiedDate

07/27/2022