TERRA LACHELLE BABCOCK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****86

License Status

NOT RENEWED

Business

First Name

TERRA

Middle

LACHELLE

Last Name

BABCOCK

Business Name

TERRA LACHELLE BABCOCK

Original Issue Date

06/15/2007

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

04/01/2010