LISA MARIE KIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****25

License Status

NOT RENEWED

Business

First Name

LISA

Middle

MARIE

Last Name

KIS

Business Name

LISA MARIE KIS

Original Issue Date

08/06/2009

Effective Date

02/17/2010

Expiration Date

03/01/2012

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/11/2012