MADISON RAE FERGUSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007303

License Status

NOT RENEWED

Business

First Name

MADISON

Middle

RAE

Last Name

FERGUSON

Business Name

MADISON RAE FERGUSON

Original Issue Date

09/26/2019

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022