SHANNON L TRUNK BROKOP Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

INOPERATIVE

Business

First Name

SHANNON

Middle

Last Name

TRUNK BROKOP

Business Name

SHANNON L TRUNK BROKOP

Original Issue Date

07/25/2006

Effective Date

01/06/2022

Expiration Date

03/01/2024

City

BRADLEY

State

Zip

60915

County

KANKAKEE

Ever Disciplined

LastModifiedDate

12/06/2023