JACQUELINE MARY BENNER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003068

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Middle

MARY

Last Name

BENNER

Business Name

JACQUELINE MARY BENNER

Original Issue Date

09/26/2007

Effective Date

01/05/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012