PENGWYNNE BLEVINS - Medical Doctor License in Illinois | # 036080252

PENGWYNNE BLEVINS

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036080252

License Status

NOT RENEWED

Business

N

First Name

PENGWYNNE

Last Name

BLEVINS

Business Name

PENGWYNNE BLEVINS

Original Issue Date

07/03/1990

Effective Date

07/03/1990

Expiration Date

07/31/2002

State

IL

Ever Disciplined

N

LastModifiedDate

10/09/2006