HEATHER LYNN KLUCK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****65

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

LYNN

Last Name

KLUCK

Business Name

HEATHER LYNN KLUCK

Original Issue Date

02/10/2005

Effective Date

01/26/2012

Expiration Date

03/01/2014

State

Ever Disciplined

LastModifiedDate

03/28/2014