DIANNA CAROL MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****42

License Status

NOT RENEWED

Business

First Name

DIANNA

Middle

CAROL

Last Name

MARTIN

Business Name

DIANNA CAROL MARTIN

Original Issue Date

12/30/2015

Effective Date

12/30/2015

Expiration Date

03/01/2018

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

05/10/2018