RYAN FERREL MANSHOLT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****24

License Status

NOT RENEWED

Business

First Name

RYAN

Middle

FERREL

Last Name

MANSHOLT

Business Name

RYAN FERREL MANSHOLT

Original Issue Date

01/31/2007

Effective Date

10/10/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

07/29/2016