RENATA B PTAK Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003716

License Status

INACTIVE

Business

First Name

RENATA

Middle

Last Name

PTAK

Business Name

RENATA B PTAK

Original Issue Date

03/31/2010

Effective Date

03/31/2010

Expiration Date

03/01/2012

City

MARSHFIELD

State

Zip

54449

County

WISCONSIN

Ever Disciplined

LastModifiedDate

12/07/2011