LAUQUYTA N WILMORE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****09

License Status

ACTIVE

Business

First Name

LAUQUYTA

Middle

Last Name

WILMORE

Business Name

LAUQUYTA N WILMORE

Original Issue Date

11/19/2015

Effective Date

01/09/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60628

County

MACON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/09/2026