LYDIA SUZANNE FULTON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****12

License Status

INOPERATIVE

Business

First Name

LYDIA

Middle

SUZANNE

Last Name

FULTON

Business Name

LYDIA SUZANNE FULTON

Original Issue Date

07/24/2009

Effective Date

03/16/2012

Expiration Date

03/01/2014

City

WAUCONDA

State

Zip

60084

County

LAKE

Ever Disciplined

LastModifiedDate

07/17/2012