KELLY MINIHANE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****69

License Status

INOPERATIVE

Business

First Name

KELLY

Last Name

MINIHANE

Business Name

KELLY MINIHANE

Original Issue Date

10/13/2010

Effective Date

02/27/2012

Expiration Date

03/01/2014

City

MENDOTA

State

Zip

61342

County

LA SALLE

Ever Disciplined

LastModifiedDate

11/14/2013