LAURA ANN BUSACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001500

License Status

NOT RENEWED

Business

First Name

LAURA

Middle

ANN

Last Name

BUSACK

Business Name

LAURA ANN BUSACK

Original Issue Date

12/05/2000

Effective Date

12/05/2000

Expiration Date

03/01/2002

City

FRANKLIN

State

Zip

53132

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006