CARRIE SUE FORTMAN Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001080

License Status

INACTIVE

Business

First Name

CARRIE

Middle

SUE

Last Name

FORTMAN

Business Name

CARRIE SUE FORTMAN

Original Issue Date

08/10/1998

Effective Date

01/10/2022

Expiration Date

03/01/2024

City

GENEVA

State

Zip

60134

County

KANE

Ever Disciplined

LastModifiedDate

02/10/2026