MELISSA L MODDRELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002953

License Status

NOT RENEWED

Business

First Name

MELISSA

Middle

Last Name

MODDRELL

Business Name

MELISSA L MODDRELL

Original Issue Date

03/19/2007

Effective Date

01/07/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022