PETRIA LAURA IDITA - Physician Assistant License in Illinois | # 085009596

PETRIA LAURA IDITA

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009596

License Status

NOT RENEWED

Business

N

First Name

PETRIA

Middle

LAURA

Last Name

IDITA

Business Name

PETRIA LAURA IDITA

Original Issue Date

03/22/2023

Effective Date

03/22/2023

Expiration Date

03/01/2024

State

IL

Ever Disciplined

N

LastModifiedDate

02/05/2025