AMY MARIE BOLT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****02

License Status

NOT RENEWED

Business

First Name

AMY

Middle

MARIE

Last Name

BOLT

Business Name

AMY MARIE BOLT

Original Issue Date

09/11/2008

Effective Date

09/11/2008

Expiration Date

03/01/2010

City

CAROL STREAM

State

Zip

60188

County

DUPAGE

Ever Disciplined

LastModifiedDate

09/22/2010