HEIDI JO DAHL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****95

License Status

NOT RENEWED

Business

First Name

HEIDI

Middle

Last Name

DAHL

Business Name

HEIDI JO DAHL

Original Issue Date

04/01/2005

Effective Date

04/01/2005

Expiration Date

03/01/2006

City

AURORA

State

Zip

60504

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006