MARA ANN PETRUCCIONE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****28

License Status

NOT RENEWED

Business

First Name

MARA

Middle

ANN

Last Name

PETRUCCIONE

Business Name

MARA ANN PETRUCCIONE

Original Issue Date

09/08/2016

Effective Date

02/13/2020

Expiration Date

03/01/2022

City

OAK LAWN

State

Zip

60453

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022