STACI DIONE BUSH Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002164

License Status

INACTIVE

Business

First Name

STACI

Middle

DIONE

Last Name

BUSH

Business Name

STACI DIONE BUSH

Original Issue Date

10/30/2003

Effective Date

04/21/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60659

County

COOK

Ever Disciplined

LastModifiedDate

03/05/2012