LAUREN GRACE HEASTON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005592

License Status

NOT RENEWED

Business

First Name

LAUREN

Middle

GRACE

Last Name

HEASTON

Business Name

LAUREN GRACE HEASTON

Original Issue Date

08/05/2015

Effective Date

02/20/2018

Expiration Date

03/01/2020

City

PHILADELPHIA

State

Zip

19103

County

PEORIA

Ever Disciplined

LastModifiedDate

11/24/2020