BRANDI VAN BOOVEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****24

License Status

INOPERATIVE

Business

First Name

BRANDI

Last Name

VAN BOOVEN

Business Name

BRANDI VAN BOOVEN

Original Issue Date

06/10/2020

Effective Date

06/10/2020

Expiration Date

03/01/2022

City

ALTON

State

Zip

62002

Ever Disciplined

LastModifiedDate

01/03/2022