STEPHANIE NICOLE BLAHA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****63

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

NICOLE

Last Name

BLAHA

Business Name

STEPHANIE NICOLE BLAHA

Original Issue Date

01/26/2021

Effective Date

01/26/2021

Expiration Date

03/01/2022

City

DECATUR

State

Zip

62526

County

MACON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022