MALLORY LYNN FILLMORE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****37

License Status

INOPERATIVE

Business

First Name

MALLORY

Middle

LYNN

Last Name

FILLMORE

Business Name

MALLORY LYNN FILLMORE

Original Issue Date

03/29/2013

Effective Date

03/11/2014

Expiration Date

03/01/2016

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Ever Disciplined

LastModifiedDate

09/09/2015