JENNIFER BLASE BRADLEY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****77

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

BLASE

Last Name

BRADLEY

Business Name

JENNIFER BLASE BRADLEY

Original Issue Date

09/15/2005

Effective Date

12/09/2009

Expiration Date

03/01/2012

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/11/2012