THERESA M FAIRBANK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002912

License Status

NOT RENEWED

Business

First Name

THERESA

Middle

Last Name

FAIRBANK

Business Name

THERESA M FAIRBANK

Original Issue Date

12/11/2006

Effective Date

12/11/2006

Expiration Date

03/01/2008

City

NASHVILLE

State

Zip

37209

Ever Disciplined

LastModifiedDate

04/23/2008