THOMAS HAROLD HANSEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****09

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

HAROLD

Last Name

HANSEN

Business Name

THOMAS HAROLD HANSEN

Original Issue Date

11/02/2009

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022