KRISTIN R LANGE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001706

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

Last Name

LANGE

Business Name

KRISTIN R LANGE

Original Issue Date

11/20/2001

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

INDIANAPOLIS

State

Zip

46240

County

INDIANA

Ever Disciplined

LastModifiedDate

05/17/2010