BREANNA LEIGH RIES Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

NOT RENEWED

Business

First Name

BREANNA

Middle

LEIGH

Last Name

RIES

Business Name

BREANNA LEIGH RIES

Original Issue Date

07/21/2009

Effective Date

02/24/2010

Expiration Date

03/01/2012

City

PARK CITY

State

Zip

60085

County

LAKE

Ever Disciplined

LastModifiedDate

04/16/2012