LACEY KATHRYN MONTGOMERY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****02

License Status

NOT RENEWED

Business

First Name

LACEY

Middle

KATHRYN

Last Name

MONTGOMERY

Business Name

LACEY KATHRYN MONTGOMERY

Original Issue Date

06/02/2004

Effective Date

03/02/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

04/16/2012