KATIE MICHELLE ROSE 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

KATIE

Middle

MICHELLE

Last Name

ROSE

Business Name

KATIE MICHELLE ROSE

Original Issue Date

12/14/2022

Effective Date

12/14/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025