AUTUMN-MARIE L GREEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004400

License Status

NOT RENEWED

Business

First Name

AUTUMN-MARIE

Middle

Last Name

GREEN

Business Name

AUTUMN-MARIE L GREEN

Original Issue Date

08/08/2012

Effective Date

02/26/2018

Expiration Date

03/01/2020

City

ROLLING MEADOWS

State

Zip

60008

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020