LISA D ECKHARDT Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****02

License Status

INOPERATIVE

Business

First Name

LISA

Middle

Last Name

ECKHARDT

Business Name

LISA D ECKHARDT

Original Issue Date

10/01/2012

Effective Date

10/01/2012

Expiration Date

03/01/2014

City

MARYVILLE

State

Zip

62062

County

MADISON

Ever Disciplined

LastModifiedDate

02/19/2014