JACQUELYNN DANIELLE BAKER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****47

License Status

INOPERATIVE

Business

First Name

JACQUELYNN

Middle

DANIELLE

Last Name

BAKER

Business Name

JACQUELYNN DANIELLE BAKER

Original Issue Date

11/04/2013

Effective Date

01/28/2014

Expiration Date

03/01/2016

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/13/2015