ELEANOR THEOBALD Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****27

License Status

INOPERATIVE

Business

First Name

ELEANOR

Last Name

THEOBALD

Business Name

ELEANOR THEOBALD

Original Issue Date

07/08/2021

Effective Date

02/09/2022

Expiration Date

03/01/2024

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

12/06/2023