KRISTIN MARIE BALTHAZOR Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****37

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

MARIE

Last Name

BALTHAZOR

Business Name

KRISTIN MARIE BALTHAZOR

Original Issue Date

08/20/2009

Effective Date

01/22/2020

Expiration Date

03/01/2022

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022