REBECCA DANIELLE BLAKKOLB Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****17

License Status

INOPERATIVE

Business

First Name

REBECCA

Middle

DANIELLE

Last Name

BLAKKOLB

Business Name

REBECCA DANIELLE BLAKKOLB

Original Issue Date

10/16/2013

Effective Date

01/13/2014

Expiration Date

03/01/2016

City

WILLOWBROOK

State

Zip

60527

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/07/2014