JADE LYAL BANNING Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004524

License Status

NOT RENEWED

Business

First Name

JADE

Middle

LYAL

Last Name

BANNING

Business Name

JADE LYAL BANNING

Original Issue Date

10/24/2012

Effective Date

02/04/2014

Expiration Date

03/01/2016

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Ever Disciplined

LastModifiedDate

01/19/2017