STEPHANIE M LAKE-MELTON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****97

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

Last Name

LAKE-MELTON

Business Name

STEPHANIE M LAKE-MELTON

Original Issue Date

09/26/2013

Effective Date

03/25/2014

Expiration Date

03/01/2016

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

03/17/2016