JILL CHRISTINE DEFAUW Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****08

License Status

NOT RENEWED

Business

First Name

JILL

Middle

CHRISTINE

Last Name

DEFAUW

Business Name

JILL CHRISTINE DEFAUW

Original Issue Date

02/26/2021

Effective Date

01/07/2022

Expiration Date

03/01/2024

City

FOREST PARK

State

Zip

60130

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025