CARLY NICOLE LARSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004730

License Status

NOT RENEWED

Business

First Name

CARLY

Middle

NICOLE

Last Name

LARSON

Business Name

CARLY NICOLE LARSON

Original Issue Date

07/22/2013

Effective Date

01/27/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

04/25/2016