WAYNE THOMAS WING Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****15

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

THOMAS

Last Name

WING

Business Name

WAYNE THOMAS WING

Original Issue Date

03/21/2002

Effective Date

12/07/2011

Expiration Date

03/01/2014

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

12/22/2015