JENNIFER LEA WALLACE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

LEA

Last Name

WALLACE

Business Name

JENNIFER LEA WALLACE

Original Issue Date

06/21/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60644

County

COOK

Ever Disciplined

LastModifiedDate

04/01/2009