MIA K PROVENZANO - Athletic Trainer License in Illinois | # 096005905

MIA K PROVENZANO

Business Entity

ACTIVE

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096005905

License Status

ACTIVE

Business

N

First Name

MIA

Middle

K

Last Name

PROVENZANO

Business Name

MIA K PROVENZANO

Original Issue Date

12/10/2024

Effective Date

12/10/2024

Expiration Date

05/31/2026

State

IL

Ever Disciplined

N

LastModifiedDate

03/04/2026