STACY LADAWN WEGNER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001529

License Status

NOT RENEWED

Business

First Name

STACY

Middle

LADAWN

Last Name

WEGNER

Business Name

STACY LADAWN WEGNER

Original Issue Date

12/12/2000

Effective Date

12/09/2009

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60605

County

COOK

Ever Disciplined

LastModifiedDate

02/09/2015