MARYANN BERTUSO 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

MARYANN

Last Name

BERTUSO

Business Name

MARYANN BERTUSO

Original Issue Date

04/04/2008

Effective Date

04/04/2008

Expiration Date

03/01/2010

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/10/2017