KINZIE G BASHLINE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004073

License Status

NOT RENEWED

Business

First Name

KINZIE

Middle

Last Name

BASHLINE

Business Name

KINZIE G BASHLINE

Original Issue Date

07/14/2011

Effective Date

02/22/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60642

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020