BETHANY JANE STORK - Physician Assistant License in Illinois | # 085003092

BETHANY JANE STORK

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003092

License Status

NOT RENEWED

Business

N

First Name

BETHANY

Middle

JANE

Last Name

STORK

Business Name

BETHANY JANE STORK

Original Issue Date

10/05/2007

Effective Date

02/24/2010

Expiration Date

03/01/2012

State

IL

Ever Disciplined

N

LastModifiedDate

04/11/2012