LARA MARCELLA MACK - Physician Assistant License in Illinois | # 085004049

LARA MARCELLA MACK

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004049

License Status

ACTIVE

Business

N

First Name

LARA

Middle

MARCELLA

Last Name

MACK

Business Name

LARA MARCELLA MACK

Original Issue Date

07/01/2011

Effective Date

12/06/2025

Expiration Date

03/01/2028

State

IL

Ever Disciplined

N

LastModifiedDate

12/06/2025