ADRIENNE NICOLE ORTMAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005737

License Status

NOT RENEWED

Business

First Name

ADRIENNE

Middle

NICOLE

Last Name

ORTMAN

Business Name

ADRIENNE NICOLE ORTMAN

Original Issue Date

11/19/2015

Effective Date

11/19/2015

Expiration Date

03/01/2016

City

PORT JEFFERSON

State

Zip

11777

County

NEW YORK

Ever Disciplined

LastModifiedDate

04/25/2016