MALLORY LYNN FILLMORE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004571

License Status

NOT RENEWED

Business

First Name

MALLORY

Middle

LYNN

Last Name

FILLMORE

Business Name

MALLORY LYNN FILLMORE

Original Issue Date

11/19/2012

Effective Date

03/11/2014

Expiration Date

03/01/2016

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Ever Disciplined

LastModifiedDate

04/25/2016