MARY L BRANDENBURG Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****95

License Status

INOPERATIVE

Business

First Name

MARY

Middle

Last Name

BRANDENBURG

Business Name

MARY L BRANDENBURG

Original Issue Date

03/09/2001

Effective Date

01/27/2014

Expiration Date

03/01/2016

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Ever Disciplined

LastModifiedDate

07/06/2015