KETURA ISIDOR Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

INOPERATIVE

Business

First Name

KETURA

Last Name

ISIDOR

Business Name

KETURA ISIDOR

Original Issue Date

07/05/2017

Effective Date

02/11/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

12/06/2023