MELANIE A SHALES Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****46

License Status

NOT RENEWED

Business

First Name

MELANIE

Middle

Last Name

SHALES

Business Name

MELANIE A SHALES

Original Issue Date

09/11/2009

Effective Date

01/22/2010

Expiration Date

03/01/2012

City

WAUCONDA

State

Zip

60084

County

LAKE

Ever Disciplined

LastModifiedDate

04/16/2012