MARY S OKOLISAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002242

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

OKOLISAN

Business Name

MARY S OKOLISAN

Original Issue Date

04/22/2004

Effective Date

01/14/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012