JILL WISE CHILDERS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

NOT RENEWED

Business

First Name

JILL

Middle

WISE

Last Name

CHILDERS

Business Name

JILL WISE CHILDERS

Original Issue Date

12/04/2003

Effective Date

02/17/2010

Expiration Date

03/01/2012

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

04/11/2012