ANISHA NICOLE JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****04

License Status

NOT RENEWED

Business

First Name

ANISHA

Middle

NICOLE

Last Name

JACKSON

Business Name

ANISHA NICOLE JACKSON

Original Issue Date

01/06/2009

Effective Date

02/26/2016

Expiration Date

03/01/2018

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Ever Disciplined

LastModifiedDate

05/08/2018