ELIZABETH HELEN EPHRAIM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

NOT RENEWED

Business

First Name

ELIZABETH

Middle

HELEN

Last Name

EPHRAIM

Business Name

ELIZABETH HELEN EPHRAIM

Original Issue Date

11/17/2017

Effective Date

02/21/2018

Expiration Date

03/01/2020

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020