ERICA MARIE DEFORD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

NOT RENEWED

Business

First Name

ERICA

Middle

MARIE

Last Name

DEFORD

Business Name

ERICA MARIE DEFORD

Original Issue Date

12/04/2007

Effective Date

02/05/2020

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61614

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022