ERINN COURTNEY FULLER 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

ERINN

Middle

COURTNEY

Last Name

FULLER

Business Name

ERINN COURTNEY FULLER

Original Issue Date

03/12/2010

Effective Date

03/06/2012

Expiration Date

03/01/2014

City

ORLAND PARK

State

Zip

60467

County

COOK

Ever Disciplined

LastModifiedDate

10/16/2014