STEPHANIE M LAKE-MELTON Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004282

License Status

INACTIVE

Business

First Name

STEPHANIE

Middle

Last Name

LAKE-MELTON

Business Name

STEPHANIE M LAKE-MELTON

Original Issue Date

02/21/2012

Effective Date

02/27/2014

Expiration Date

03/01/2016

City

BELOIT

State

Zip

53511

Ever Disciplined

LastModifiedDate

03/06/2025