MARY JO RUSSELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****32

License Status

NOT RENEWED

Business

First Name

MARY JO

Last Name

RUSSELL

Business Name

MARY JO RUSSELL

Original Issue Date

03/23/2015

Effective Date

03/23/2015

Expiration Date

03/01/2016

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

03/24/2016