COURTNEY LYNN TELLER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****57

License Status

NOT RENEWED

Business

First Name

COURTNEY

Middle

LYNN

Last Name

TELLER

Business Name

COURTNEY LYNN TELLER

Original Issue Date

08/23/2012

Effective Date

03/03/2020

Expiration Date

03/01/2022

City

DIXON

State

Zip

61021

County

LEE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022