CAMERON TROY JACKSON STENGEL Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****17

License Status

INOPERATIVE

Business

First Name

CAMERON

Middle

TROY JACKSON

Last Name

STENGEL

Business Name

CAMERON TROY JACKSON STENGEL

Original Issue Date

10/16/2019

Effective Date

02/20/2020

Expiration Date

03/01/2022

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

01/03/2022