KRISTIN LIETZAU Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

ACTIVE

Business

First Name

KRISTIN

Last Name

LIETZAU

Business Name

KRISTIN LIETZAU

Original Issue Date

03/03/2020

Effective Date

02/19/2026

Expiration Date

03/01/2028

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/19/2026