SARA MARIE DICKEN 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

SARA

Middle

MARIE

Last Name

DICKEN

Business Name

SARA MARIE DICKEN

Original Issue Date

04/01/2005

Effective Date

01/19/2010

Expiration Date

03/01/2012

City

MILAN

State

Zip

61264

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

07/20/2012