ANGELA MARIE RUSSELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****36

License Status

NOT RENEWED

Business

First Name

ANGELA

Middle

MARIE

Last Name

RUSSELL

Business Name

ANGELA MARIE RUSSELL

Original Issue Date

07/29/2014

Effective Date

02/16/2016

Expiration Date

03/01/2018

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/10/2018