VALERIE ANASTASIA CARROLL Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

INOPERATIVE

Business

First Name

VALERIE

Middle

ANASTASIA

Last Name

CARROLL

Business Name

VALERIE ANASTASIA CARROLL

Original Issue Date

08/20/2007

Effective Date

01/10/2012

Expiration Date

03/01/2014

City

MADISON

State

Zip

53703

County

WISCONSIN

Ever Disciplined

LastModifiedDate

07/17/2012