STEPHEN CHRISTOPHER PROVENZA Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003965

License Status

INACTIVE

Business

First Name

STEPHEN

Middle

CHRISTOPHER

Last Name

PROVENZA

Business Name

STEPHEN CHRISTOPHER PROVENZA

Original Issue Date

12/02/2010

Effective Date

01/29/2014

Expiration Date

03/01/2016

City

COLUMBUS

State

Zip

47201

County

INDIANA

Ever Disciplined

LastModifiedDate

01/21/2016