REGAN RUSS MILLER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005034

License Status

NOT RENEWED

Business

First Name

REGAN

Middle

RUSS

Last Name

MILLER

Business Name

REGAN RUSS MILLER

Original Issue Date

04/01/2014

Effective Date

02/25/2016

Expiration Date

03/01/2018

City

FARGO

State

Zip

58104

County

NORTH DAKOTA

Ever Disciplined

LastModifiedDate

05/10/2018