KELSEY LASAGE MAZUR Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****01

License Status

NOT RENEWED

Business

First Name

KELSEY

Middle

LASAGE

Last Name

MAZUR

Business Name

KELSEY LASAGE MAZUR

Original Issue Date

02/08/2018

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60612

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022