LAUREN F PROVENZANO Athletic Trainer License verification

Business Entity

NOT RENEWED

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096001039

License Status

NOT RENEWED

Business

First Name

LAUREN F

Last Name

PROVENZANO

Business Name

LAUREN F PROVENZANO

Original Issue Date

09/10/1997

Effective Date

07/17/2000

Expiration Date

05/31/2000

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005