FALLON ANN CLANCY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006875

License Status

NOT RENEWED

Business

First Name

FALLON

Middle

ANN

Last Name

CLANCY

Business Name

FALLON ANN CLANCY

Original Issue Date

12/07/2018

Effective Date

12/07/2018

Expiration Date

03/01/2020

City

IRA

State

Zip

48023

Ever Disciplined

LastModifiedDate

11/24/2020