LORENA JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****44

License Status

NOT RENEWED

Business

First Name

LORENA

Last Name

JOHNSON

Business Name

LORENA JOHNSON

Original Issue Date

01/26/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/01/2010