STACI DIONE BUSH - Physician Assistant License in Illinois | # 085002164

STACI DIONE BUSH

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002164

License Status

INACTIVE

Business

N

First Name

STACI

Middle

DIONE

Last Name

BUSH

Business Name

STACI DIONE BUSH

Original Issue Date

10/30/2003

Effective Date

04/21/2010

Expiration Date

03/01/2012

State

IL

Ever Disciplined

N

LastModifiedDate

03/05/2012