SARAH E GUASTALLI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****25

License Status

NOT RENEWED

Business

First Name

SARAH

Middle

Last Name

GUASTALLI

Business Name

SARAH E GUASTALLI

Original Issue Date

12/02/2014

Effective Date

02/21/2018

Expiration Date

03/01/2020

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020