KRISTIE LEE SHIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****40

License Status

NOT RENEWED

Business

First Name

KRISTIE

Middle

LEE

Last Name

SHIN

Business Name

KRISTIE LEE SHIN

Original Issue Date

09/03/2009

Effective Date

09/28/2016

Expiration Date

03/01/2018

City

OTTAWA

State

Zip

61350

County

LA SALLE

Ever Disciplined

LastModifiedDate

05/10/2018