ANNELIESE HEATHER MIZWICKI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004779

License Status

NOT RENEWED

Business

First Name

ANNELIESE

Middle

HEATHER

Last Name

MIZWICKI

Business Name

ANNELIESE HEATHER MIZWICKI

Original Issue Date

07/26/2013

Effective Date

01/02/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022