CARRIE SUE FORTMAN Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****21

License Status

INACTIVE

Business

First Name

CARRIE

Middle

SUE

Last Name

FORTMAN

Business Name

CARRIE SUE FORTMAN

Original Issue Date

03/09/2001

Effective Date

01/11/2022

Expiration Date

03/01/2024

City

ELGIN

State

Zip

60123

County

DUPAGE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/10/2026