BETHANY JANE STORK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003092

License Status

NOT RENEWED

Business

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

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

04/11/2012