AMBER DIANE DEVINE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004499

License Status

NOT RENEWED

Business

First Name

AMBER

Middle

DIANE

Last Name

DEVINE

Business Name

AMBER DIANE DEVINE

Original Issue Date

10/12/2012

Effective Date

10/12/2012

Expiration Date

03/01/2014

City

KENOSHA

State

Zip

53140

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/08/2014