ERICA MARIE DEFORD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003126

License Status

NOT RENEWED

Business

First Name

ERICA

Middle

MARIE

Last Name

DEFORD

Business Name

ERICA MARIE DEFORD

Original Issue Date

10/23/2007

Effective Date

02/05/2020

Expiration Date

03/01/2022

City

EAST PEORIA

State

Zip

61611

County

TAZEWELL

Ever Disciplined

LastModifiedDate

07/27/2022