CAROLYN MARIE BRUNNER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****53

License Status

NOT RENEWED

Business

First Name

CAROLYN

Middle

MARIE

Last Name

BRUNNER

Business Name

CAROLYN MARIE BRUNNER

Original Issue Date

10/04/2010

Effective Date

02/25/2014

Expiration Date

03/01/2016

City

COLUMBIA

State

Zip

62236

County

MONROE

Ever Disciplined

LastModifiedDate

04/25/2016