INGA LIESE STORBAKKEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****93

License Status

NOT RENEWED

Business

First Name

INGA

Middle

LIESE

Last Name

STORBAKKEN

Business Name

INGA LIESE STORBAKKEN

Original Issue Date

02/25/2008

Effective Date

03/03/2020

Expiration Date

03/01/2022

City

AUSTIN

State

Zip

78739

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022