MIRANDA L BOECKMAN 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

MIRANDA

Middle

Last Name

BOECKMAN

Business Name

MIRANDA L BOECKMAN

Original Issue Date

03/10/2015

Effective Date

02/17/2016

Expiration Date

03/01/2018

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

05/02/2018