MICHAELA ROSE BLACKWELL Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****50

License Status

ACTIVE

Business

First Name

MICHAELA

Middle

ROSE

Last Name

BLACKWELL

Business Name

MICHAELA ROSE BLACKWELL

Original Issue Date

11/08/2024

Effective Date

11/08/2024

Expiration Date

03/01/2026

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025