LORI A STUPP BOBULA 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

LORI

Middle

Last Name

STUPP BOBULA

Business Name

LORI A STUPP BOBULA

Original Issue Date

10/01/2014

Effective Date

02/23/2018

Expiration Date

03/01/2020

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020