MICAH LYNN ANN CLUTTER 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

MICAH

Middle

LYNN ANN

Last Name

CLUTTER

Business Name

MICAH LYNN ANN CLUTTER

Original Issue Date

07/31/2020

Effective Date

02/24/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/05/2025