TRACIE MARIE KOEBCKE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****20

License Status

INOPERATIVE

Business

First Name

TRACIE

Middle

MARIE

Last Name

KOEBCKE

Business Name

TRACIE MARIE KOEBCKE

Original Issue Date

10/18/2012

Effective Date

02/14/2014

Expiration Date

03/01/2016

City

WATSEKA

State

Zip

60970

County

IROQUOIS

Ever Disciplined

LastModifiedDate

03/25/2014