MARYELLEN IACOVACCI BLEVINS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009743

License Status

NOT RENEWED

Business

First Name

MARYELLEN

Middle

IACOVACCI

Last Name

BLEVINS

Business Name

MARYELLEN IACOVACCI BLEVINS

Original Issue Date

06/28/2023

Effective Date

06/28/2023

Expiration Date

03/01/2024

City

ELLICOTTVILLE

State

Zip

14731

Ever Disciplined

LastModifiedDate

02/05/2025