LOREN CLAIRE MARIE 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

LOREN

Middle

CLAIRE

Last Name

MARIE

Business Name

LOREN CLAIRE MARIE

Original Issue Date

12/17/2004

Effective Date

02/10/2010

Expiration Date

03/01/2012

City

NORMAL

State

Zip

61761

County

MCLEAN

Ever Disciplined

LastModifiedDate

04/16/2012