HEATHER ANNE KONZELMANN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****06

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

ANNE

Last Name

KONZELMANN

Business Name

HEATHER ANNE KONZELMANN

Original Issue Date

09/16/2008

Effective Date

02/26/2014

Expiration Date

03/01/2016

City

MAHOMET

State

Zip

61853

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

04/25/2016