SHANNON MILLER 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

SHANNON

Last Name

MILLER

Business Name

SHANNON MILLER

Original Issue Date

12/14/2001

Effective Date

02/04/2020

Expiration Date

03/01/2022

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/27/2022