PETRIA LAURA IDITA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009596

License Status

NOT RENEWED

Business

First Name

PETRIA

Middle

LAURA

Last Name

IDITA

Business Name

PETRIA LAURA IDITA

Original Issue Date

03/22/2023

Effective Date

03/22/2023

Expiration Date

03/01/2024

City

CHICAGO

State

Zip

60611

County

ADAMS

Ever Disciplined

LastModifiedDate

02/05/2025