SHANNON ROOT 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

SHANNON

Last Name

ROOT

Business Name

SHANNON ROOT

Original Issue Date

06/09/2021

Effective Date

06/27/2021

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61615

Delegated Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

07/27/2022