KIERSTYN L BLOCK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003444

License Status

NOT RENEWED

Business

First Name

KIERSTYN

Middle

Last Name

BLOCK

Business Name

KIERSTYN L BLOCK

Original Issue Date

03/04/2009

Effective Date

02/04/2010

Expiration Date

03/01/2012

City

MADISON

State

Zip

53719

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/11/2012