LISA M DI SANDRO Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****93

License Status

NOT RENEWED

Business

First Name

LISA

Middle

Last Name

DI SANDRO

Business Name

LISA M DI SANDRO

Original Issue Date

02/10/2003

Effective Date

02/10/2003

Expiration Date

03/01/2004

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006