MELISSA L MODDRELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****27

License Status

NOT RENEWED

Business

First Name

MELISSA

Middle

Last Name

MODDRELL

Business Name

MELISSA L MODDRELL

Original Issue Date

04/09/2008

Effective Date

01/07/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60614

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022