KRISTA RAE MOHAMED 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

KRISTA

Middle

RAE

Last Name

MOHAMED

Business Name

KRISTA RAE MOHAMED

Original Issue Date

09/03/2010

Effective Date

12/19/2011

Expiration Date

03/01/2014

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/25/2012