Stephen Christopher Provenza
InactiveIllinois license 085003965
License
- Licensed by
- Illinois Department of Financial and Professional Regulation
- License number
- 085003965
- Status
- Inactive
- First issued
- December 2, 2010
- Expired
- March 1, 2016
- License holder
- Stephen Christopher Provenza
- Entity type
- Individual
Classifications
- Licensed Physician Assistant Physicians & Surgeons
More from the license record
- Current term began
- 01/29/2014
Contact
Columbus, IN 47201
Indiana County