MEGAN M WIESEL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****71

License Status

NOT RENEWED

Business

First Name

MEGAN

Middle

Last Name

WIESEL

Business Name

MEGAN M WIESEL

Original Issue Date

03/11/2004

Effective Date

03/11/2004

Expiration Date

03/01/2006

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

10/09/2006