JESSICA LACIE WAGNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049290

License Status

EXPIRED

Business

First Name

JESSICA

Middle

LACIE

Last Name

WAGNER

Suffix

Business Name

JESSICA LACIE WAGNER MD

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/23/2006

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006