BRIAN KEITH NORDGREN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****70

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

KEITH

Last Name

NORDGREN

Business Name

BRIAN KEITH NORDGREN

Original Issue Date

03/15/2012

Effective Date

03/15/2012

Expiration Date

03/01/2014

State

Ever Disciplined

LastModifiedDate

03/28/2014