LISA MARGARET REZAC 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

LISA

Middle

MARGARET

Last Name

REZAC

Business Name

LISA MARGARET REZAC

Original Issue Date

01/14/2004

Effective Date

01/14/2004

Expiration Date

03/01/2006

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

09/26/2006