GLENN ADAM PETERSON - Physician Assistant License in Illinois | # 085006213

GLENN ADAM PETERSON

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006213

License Status

NOT RENEWED

Business

N

First Name

GLENN

Middle

ADAM

Last Name

PETERSON

Business Name

GLENN ADAM PETERSON

Original Issue Date

06/22/2017

Effective Date

02/13/2020

Expiration Date

03/01/2022

State

IL

Ever Disciplined

N

LastModifiedDate

07/27/2022