KASEY L PONTARELLI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****99

License Status

NOT RENEWED

Business

First Name

KASEY

Middle

Last Name

PONTARELLI

Business Name

KASEY L PONTARELLI

Original Issue Date

11/09/2015

Effective Date

02/25/2022

Expiration Date

03/01/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025