DIANE R JOHNSON PA
Physician Assistant


Address: 5841 Route 112, Halifax, VT 05358

DIANE R JOHNSON PA (Credential# 742784) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is November 17, 2008. The license expiration date date is November 30, 2009. The license status is INACTIVE.

Business Overview

DIANE R JOHNSON PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001035. The credential type is physician assistant. The effective date is November 17, 2008. The expiration date is November 30, 2009. The business address is 5841 Route 112, Halifax, VT 05358. The current status is inactive.

Basic Information

Licensee Name DIANE R JOHNSON PA
Credential ID 742784
Credential Number 23.001035
Credential Type Physician Assistant
Business Address 5841 Route 112
Halifax
VT 05358
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2000-11-29
Effective Date 2008-11-17
Expiration Date 2009-11-30
Refresh Date 2010-03-16

Other licenses

ID Credential Code Credential Type Issue Term Status
260865 CSP.0030511 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2005-03-01 2008-03-01 - 2009-02-28 INACTIVE

Office Location

Street Address 5841 ROUTE 112
City HALIFAX
State VT
Zip Code 05358

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Honora Winery & Vineyard Inc · Honora Winery 1950 Collins Road, West Halifax, VT 05358 Out of State Winery 2010-04-08 ~ 2011-04-07
Benjamin J Reynolds 801 Deer Park Rd, West Halifax, VT 05358-7932 Asbestos Abatement Supervisor 2017-06-15 ~ 2018-09-30

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Gary Carlson 212 Thompson St, Halifax, MA 02338-1614 Electrical Unlimited Journeyperson 2016-10-01 ~ 2017-09-30
Lea C Mason 390 Plymouth St, Halifax, MA 02338-1343 Emergency Medical Technician 2018-06-25 ~ 2020-04-01
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City HALIFAX
Zip Code 05358
License Type Physician Assistant
License Type + County Physician Assistant + HALIFAX

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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