KATHERINE A TETRAULT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****01

License Status

NOT RENEWED

Business

First Name

KATHERINE

Middle

Last Name

TETRAULT

Business Name

KATHERINE A TETRAULT

Original Issue Date

08/25/2010

Effective Date

02/27/2012

Expiration Date

03/01/2014

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

10/29/2015