TAYLOR DATTOLO Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****03

License Status

INOPERATIVE

Business

First Name

TAYLOR

Last Name

DATTOLO

Business Name

TAYLOR DATTOLO

Original Issue Date

06/07/2021

Effective Date

01/08/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

12/06/2023