STACY LADAWN WEGNER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

NOT RENEWED

Business

First Name

STACY

Middle

LADAWN

Last Name

WEGNER

Business Name

STACY LADAWN WEGNER

Original Issue Date

07/20/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60641

County

COOK

Ever Disciplined

LastModifiedDate

02/09/2015