AUTUMN-MARIE L GREEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****29

License Status

INOPERATIVE

Business

First Name

AUTUMN-MARIE

Middle

Last Name

GREEN

Business Name

AUTUMN-MARIE L GREEN

Original Issue Date

10/24/2012

Effective Date

02/26/2018

Expiration Date

03/01/2020

City

ROLLING MEADOWS

State

Zip

60008

County

COOK

Ever Disciplined

LastModifiedDate

12/18/2019