MARIE ANNETTE HERZOG 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

MARIE

Middle

ANNETTE

Last Name

HERZOG

Business Name

MARIE ANNETTE HERZOG

Original Issue Date

07/29/2015

Effective Date

02/10/2016

Expiration Date

03/01/2018

City

PEKIN

State

Zip

61554

County

TAZEWELL

Ever Disciplined

LastModifiedDate

05/10/2018