BRANDY LADORA MACON - Physician Assistant License in Illinois | # 085006152

BRANDY LADORA MACON

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006152

License Status

NOT RENEWED

Business

N

First Name

BRANDY

Middle

LADORA

Last Name

MACON

Business Name

BRANDY LADORA MACON

Original Issue Date

03/14/2017

Effective Date

01/12/2022

Expiration Date

03/01/2024

State

IL

Ever Disciplined

N

LastModifiedDate

02/05/2025