STEPHANIE M ELLIS Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****44

License Status

INOPERATIVE

Business

First Name

STEPHANIE

Middle

Last Name

ELLIS

Business Name

STEPHANIE M ELLIS

Original Issue Date

09/21/2010

Effective Date

02/17/2022

Expiration Date

03/01/2024

City

TROY

State

Zip

62294

County

MADISON

Ever Disciplined

LastModifiedDate

12/06/2023