CONSTANCE LYNN HANNINEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

INOPERATIVE

Business

First Name

CONSTANCE

Middle

LYNN

Last Name

HANNINEN

Business Name

CONSTANCE LYNN HANNINEN

Original Issue Date

05/22/2012

Effective Date

03/18/2014

Expiration Date

03/01/2016

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Ever Disciplined

LastModifiedDate

03/05/2014