MOLLIE J BERG Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003481

License Status

INACTIVE

Business

First Name

MOLLIE

Middle

Last Name

BERG

Business Name

MOLLIE J BERG

Original Issue Date

06/25/2009

Effective Date

06/25/2009

Expiration Date

03/01/2010

City

WAUSAU

State

Zip

54403

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/22/2010