STEPHANIE NICOLE BLAHA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007939

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

NICOLE

Last Name

BLAHA

Business Name

STEPHANIE NICOLE BLAHA

Original Issue Date

09/10/2020

Effective Date

09/10/2020

Expiration Date

03/01/2022

City

RACINE

State

Zip

53402

Ever Disciplined

LastModifiedDate

07/27/2022