KIMBERLY NICOLE LAVELLE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004129

License Status

NOT RENEWED

Business

First Name

KIMBERLY

Middle

NICOLE

Last Name

LAVELLE

Business Name

KIMBERLY NICOLE LAVELLE

Original Issue Date

09/14/2011

Effective Date

02/02/2016

Expiration Date

03/01/2018

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

08/27/2018