KRISTEN ELIZABETH SLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005313

License Status

NOT RENEWED

Business

First Name

KRISTEN

Middle

ELIZABETH

Last Name

SLACK

Business Name

KRISTEN ELIZABETH SLACK

Original Issue Date

10/14/2014

Effective Date

10/14/2014

Expiration Date

03/01/2016

City

NORTHVILLE

State

Zip

48168

County

MICHIGAN

Ever Disciplined

LastModifiedDate

04/25/2016