HALEY ANN BLOOM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006477

License Status

NOT RENEWED

Business

First Name

HALEY

Middle

ANN

Last Name

BLOOM

Business Name

HALEY ANN BLOOM

Original Issue Date

01/04/2018

Effective Date

02/25/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60613

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022