ANDREA MARIE GOODMAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004195

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

MARIE

Last Name

GOODMAN

Business Name

ANDREA MARIE GOODMAN

Original Issue Date

10/12/2011

Effective Date

01/07/2020

Expiration Date

03/01/2022

City

EDGEWOOD

State

Zip

87015

Ever Disciplined

LastModifiedDate

07/27/2022