GINA MARIE FASANO PA-C Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007646

License Status

NOT RENEWED

Business

Title

PA-C

First Name

GINA

Middle

MARIE

Last Name

FASANO

Business Name

GINA MARIE FASANO PA-C

Original Issue Date

05/04/2020

Effective Date

05/04/2020

Expiration Date

03/01/2022

City

LONG GROVE

State

Zip

60047

County

LAKE

Ever Disciplined

LastModifiedDate

07/27/2022