LACEY KATHRYN MONTGOMERY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002214

License Status

NOT RENEWED

Business

First Name

LACEY

Middle

KATHRYN

Last Name

MONTGOMERY

Business Name

LACEY KATHRYN MONTGOMERY

Original Issue Date

02/23/2004

Effective Date

03/02/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012