BETHANY JANE STORK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****51

License Status

NOT RENEWED

Business

First Name

BETHANY

Middle

JANE

Last Name

STORK

Business Name

BETHANY JANE STORK

Original Issue Date

12/18/2007

Effective Date

02/24/2010

Expiration Date

03/01/2012

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

04/16/2012