MICHELE NICOLE BRANDHAGEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****18

License Status

INOPERATIVE

Business

First Name

MICHELE

Middle

NICOLE

Last Name

BRANDHAGEN

Business Name

MICHELE NICOLE BRANDHAGEN

Original Issue Date

11/17/2014

Effective Date

11/17/2014

Expiration Date

03/01/2016

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

11/17/2014