JENNIFER ANN STORM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****45

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

ANN

Last Name

STORM

Business Name

JENNIFER ANN STORM

Original Issue Date

06/26/2008

Effective Date

05/16/2019

Expiration Date

03/01/2020

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020