MEGAN MAE PENFOLD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003024

License Status

NOT RENEWED

Business

First Name

MEGAN

Middle

MAE

Last Name

PENFOLD

Business Name

MEGAN MAE PENFOLD

Original Issue Date

08/20/2007

Effective Date

01/22/2010

Expiration Date

03/01/2012

City

KENOSHA

State

Zip

53142

County

WISCONSIN

Ever Disciplined

LastModifiedDate

01/02/2015