REBEKAH MARIE BLANK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****58

License Status

ACTIVE

Business

First Name

REBEKAH

Middle

MARIE

Last Name

BLANK

Business Name

REBEKAH MARIE BLANK

Original Issue Date

03/25/2020

Effective Date

02/21/2024

Expiration Date

03/01/2026

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025