MIA K PROVENZANO Athletic Trainer License verification

Business Entity

ACTIVE

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096005905

License Status

ACTIVE

Business

First Name

MIA

Middle

Last Name

PROVENZANO

Business Name

MIA K PROVENZANO

Original Issue Date

12/10/2024

Effective Date

12/10/2024

Expiration Date

05/31/2026

City

GLENCOE

State

Zip

60022

County

COOK

Ever Disciplined

LastModifiedDate

03/04/2026