GINA MICHELLE LUCKIANOW Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002378

License Status

NOT RENEWED

Business

First Name

GINA

Middle

MICHELLE

Last Name

LUCKIANOW

Business Name

GINA MICHELLE LUCKIANOW

Original Issue Date

10/08/2004

Effective Date

10/08/2004

Expiration Date

03/01/2006

City

WAYNE

State

Zip

19087

County

PENNSYLVANIA

Ever Disciplined

LastModifiedDate

10/09/2006