TAMI JADVIGA DZIEDZIC 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

TAMI

Middle

JADVIGA

Last Name

DZIEDZIC

Business Name

TAMI JADVIGA DZIEDZIC

Original Issue Date

01/26/2005

Effective Date

03/01/2016

Expiration Date

03/01/2018

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/02/2018