AMY B BERGHOFF Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005309

License Status

NOT RENEWED

Business

First Name

AMY

Middle

Last Name

BERGHOFF

Business Name

AMY B BERGHOFF

Original Issue Date

10/09/2014

Effective Date

03/02/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60661

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020