MARA ANN PETRUCCIONE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005870

License Status

NOT RENEWED

Business

First Name

MARA

Middle

ANN

Last Name

PETRUCCIONE

Business Name

MARA ANN PETRUCCIONE

Original Issue Date

07/05/2016

Effective Date

02/04/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60647

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022