JENNIFER BROOKE RUSSELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004452

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

BROOKE

Last Name

RUSSELL

Business Name

JENNIFER BROOKE RUSSELL

Original Issue Date

09/17/2012

Effective Date

09/17/2012

Expiration Date

03/01/2014

City

GLENVILLE

State

Zip

12302

County

NEW YORK

Ever Disciplined

LastModifiedDate

04/08/2014