LYDIA SUZANNE FULTON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003502

License Status

NOT RENEWED

Business

First Name

LYDIA

Middle

SUZANNE

Last Name

FULTON

Business Name

LYDIA SUZANNE FULTON

Original Issue Date

07/10/2009

Effective Date

03/16/2012

Expiration Date

03/01/2014

City

ALGONQUIN

State

Zip

60102

County

MCHENRY

Ever Disciplined

LastModifiedDate

04/08/2014