NATHAN A DE WITT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002449

License Status

NOT RENEWED

Business

First Name

NATHAN

Middle

Last Name

DE WITT

Business Name

NATHAN A DE WITT

Original Issue Date

01/14/2005

Effective Date

03/15/2016

Expiration Date

03/01/2018

City

PUYALLUP

State

Zip

98375

Ever Disciplined

LastModifiedDate

05/10/2018