ANDREA MARIE GOODMAN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****59

License Status

INOPERATIVE

Business

First Name

ANDREA

Middle

MARIE

Last Name

GOODMAN

Business Name

ANDREA MARIE GOODMAN

Original Issue Date

02/23/2012

Effective Date

02/05/2016

Expiration Date

03/01/2018

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

05/02/2018