CRYSTAL LEA KITTISOPIKUL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006306

License Status

NOT RENEWED

Business

First Name

CRYSTAL

Middle

LEA

Last Name

KITTISOPIKUL

Business Name

CRYSTAL LEA KITTISOPIKUL

Original Issue Date

08/14/2017

Effective Date

12/27/2019

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022