KATIE MARIE DIENELL 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

KATIE

Middle

MARIE

Last Name

DIENELL

Business Name

KATIE MARIE DIENELL

Original Issue Date

09/07/2017

Effective Date

02/27/2018

Expiration Date

03/01/2020

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

12/18/2019