DEANNE JANET FOWLER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****50

License Status

INOPERATIVE

Business

First Name

DEANNE

Middle

JANET

Last Name

FOWLER

Business Name

DEANNE JANET FOWLER

Original Issue Date

11/02/2012

Effective Date

02/18/2020

Expiration Date

03/01/2022

City

CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Ever Disciplined

LastModifiedDate

01/03/2022