MELISSA RENEE BACYINSKI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****30

License Status

NOT RENEWED

Business

First Name

MELISSA

Middle

RENEE

Last Name

BACYINSKI

Business Name

MELISSA RENEE BACYINSKI

Original Issue Date

08/17/2004

Effective Date

08/17/2004

Expiration Date

03/01/2006

City

CHICAGO

State

Zip

60631

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006