LEIGH ELLEN VANTIMMEREN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****24

License Status

NOT RENEWED

Business

First Name

LEIGH

Middle

ELLEN

Last Name

VANTIMMEREN

Business Name

LEIGH ELLEN VANTIMMEREN

Original Issue Date

06/07/2016

Effective Date

02/20/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60612

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022