TAMARA ANN FREDERICK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****14

License Status

INOPERATIVE

Business

First Name

TAMARA

Middle

ANN

Last Name

FREDERICK

Business Name

TAMARA ANN FREDERICK

Original Issue Date

01/20/2009

Effective Date

02/25/2020

Expiration Date

03/01/2022

City

PLAINFIELD

State

Zip

60585

County

COOK

Ever Disciplined

LastModifiedDate

01/03/2022