GWEN S LONG Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000397

License Status

INACTIVE

Business

First Name

GWEN

Middle

Last Name

LONG

Business Name

GWEN S LONG

Original Issue Date

02/23/1990

Effective Date

05/06/2008

Expiration Date

03/01/2010

City

MADISON

State

Zip

53717

Ever Disciplined

LastModifiedDate

12/09/2009