AMANDA CHRISTINE BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002890

License Status

NOT RENEWED

Business

First Name

AMANDA

Middle

CHRISTINE

Last Name

BLACK

Business Name

AMANDA CHRISTINE BLACK

Original Issue Date

11/15/2006

Effective Date

11/15/2006

Expiration Date

03/01/2008

City

SAINT LOUIS

State

Zip

63129

Ever Disciplined

LastModifiedDate

04/23/2008