KIMBERLY ANN SHAW 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

KIMBERLY

Middle

ANN

Last Name

SHAW

Business Name

KIMBERLY ANN SHAW

Original Issue Date

03/08/2002

Effective Date

02/14/2008

Expiration Date

03/01/2010

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

12/23/2010