AMY M PETTY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002349

License Status

NOT RENEWED

Business

First Name

AMY

Middle

Last Name

PETTY

Business Name

AMY M PETTY

Original Issue Date

09/23/2004

Effective Date

09/23/2004

Expiration Date

03/01/2006

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006