License Verification

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CODY WISSENBACH

License Number: PA9114334

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9114334
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
04/22/2021
Address of Record
1055 North Curtis Rd
BOISE, ID 83706
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
CANALIZO, JOHN BUCKLEY Supervising Prescribing Practitioner Medical Doctor 67318 04/26/2022
CANTU, MONICA EDITH Supervising Prescribing Practitioner Medical Doctor 122370 04/26/2022
FUNK, KEVIN ANDRE Supervising Prescribing Practitioner Medical Doctor 144992 04/26/2022
ROMACK, REBECCA Supervising Prescribing Practitioner Medical Doctor 132598 04/26/2022

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/23/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


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