FELVA COLLIE LUCK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****14

License Status

INOPERATIVE

Business

First Name

FELVA

Middle

COLLIE

Last Name

LUCK

Business Name

FELVA COLLIE LUCK

Original Issue Date

11/05/2009

Effective Date

03/02/2012

Expiration Date

03/01/2014

City

WAYNE CITY

State

Zip

62895

County

WAYNE

Ever Disciplined

LastModifiedDate

03/02/2012