KRISTINE S ANDERSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****11

License Status

NOT RENEWED

Business

First Name

KRISTINE

Middle

Last Name

ANDERSON

Business Name

KRISTINE S ANDERSON

Original Issue Date

07/23/2009

Effective Date

02/22/2018

Expiration Date

03/01/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020