HALEY ANN BLOOM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

NOT RENEWED

Business

First Name

HALEY

Middle

ANN

Last Name

BLOOM

Business Name

HALEY ANN BLOOM

Original Issue Date

04/25/2018

Effective Date

12/18/2019

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60657

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022