JOLENA MARIE MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

NOT RENEWED

Business

First Name

JOLENA

Middle

MARIE

Last Name

MARTIN

Business Name

JOLENA MARIE MARTIN

Original Issue Date

10/10/2006

Effective Date

04/12/2018

Expiration Date

03/01/2020

City

CHARLESTON

State

Zip

61920

County

COLES

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020