ASHLEY ROSE DERIEMACKER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004608

License Status

NOT RENEWED

Business

First Name

ASHLEY

Middle

ROSE

Last Name

DERIEMACKER

Business Name

ASHLEY ROSE DERIEMACKER

Original Issue Date

01/31/2013

Effective Date

07/17/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

04/25/2016