BRIANNE ELIZABETH ANCICH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002633

License Status

NOT RENEWED

Business

First Name

BRIANNE

Middle

ELIZABETH

Last Name

ANCICH

Business Name

BRIANNE ELIZABETH ANCICH

Original Issue Date

10/21/2005

Effective Date

10/21/2005

Expiration Date

03/01/2006

City

INDIANAPOLIS

State

Zip

46237

County

INDIANA

Ever Disciplined

LastModifiedDate

10/09/2006