JONATHAN E BOLLES Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

INOPERATIVE

Business

First Name

JONATHAN

Middle

Last Name

BOLLES

Business Name

JONATHAN E BOLLES

Original Issue Date

01/27/2009

Effective Date

04/22/2020

Expiration Date

03/01/2022

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

01/03/2022