SHANNON L GULLINGSRUD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005008

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

Last Name

GULLINGSRUD

Business Name

SHANNON L GULLINGSRUD

Original Issue Date

03/20/2014

Effective Date

02/08/2016

Expiration Date

03/01/2018

City

CARPENTERSVILLE

State

Zip

60110

County

KANE

Ever Disciplined

LastModifiedDate

05/10/2018