AUTUMN A JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002717

License Status

NOT RENEWED

Business

First Name

AUTUMN

Middle

Last Name

JACKSON

Business Name

AUTUMN A JACKSON

Original Issue Date

05/22/2006

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

11/18/2010