ALLYSE MARIE MERVIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004502

License Status

NOT RENEWED

Business

First Name

ALLYSE

Middle

MARIE

Last Name

MERVIN

Business Name

ALLYSE MARIE MERVIN

Original Issue Date

10/16/2012

Effective Date

10/16/2012

Expiration Date

03/01/2014

City

GREENDALE

State

Zip

53129

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/08/2014