JACQUELINE MARY BENNER - Physician Assistant License in Illinois | # 085003068

JACQUELINE MARY BENNER

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003068

License Status

NOT RENEWED

Business

N

First Name

JACQUELINE

Middle

MARY

Last Name

BENNER

Business Name

JACQUELINE MARY BENNER

Original Issue Date

09/26/2007

Effective Date

01/05/2010

Expiration Date

03/01/2012

State

IL

Ever Disciplined

N

LastModifiedDate

04/11/2012