ANDREW L LANGE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002426

License Status

NOT RENEWED

Business

First Name

ANDREW

Middle

Last Name

LANGE

Business Name

ANDREW L LANGE

Original Issue Date

12/07/2004

Effective Date

12/07/2004

Expiration Date

03/01/2008

City

WAUKESHA

State

Zip

53188

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/23/2008