KIMBERLY NICOLE LAVELLE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

INOPERATIVE

Business

First Name

KIMBERLY

Middle

NICOLE

Last Name

LAVELLE

Business Name

KIMBERLY NICOLE LAVELLE

Original Issue Date

10/13/2011

Effective Date

01/31/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60649

County

COOK

Ever Disciplined

LastModifiedDate

01/17/2014