KELLI ELAINE GROOMER 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

KELLI

Middle

ELAINE

Last Name

GROOMER

Business Name

KELLI ELAINE GROOMER

Original Issue Date

10/01/2012

Effective Date

02/08/2016

Expiration Date

03/01/2018

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/10/2018