STACI DIONE BUSH Physician Assistant License verification

Business Entity

CANCELLED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

CANCELLED

Business

First Name

STACI

Middle

DIONE

Last Name

BUSH

Business Name

STACI DIONE BUSH

Original Issue Date

07/28/2004

Effective Date

04/21/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60659

County

COOK

Ever Disciplined

LastModifiedDate

03/05/2012