KATINA DAWN WALLINE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****53

License Status

NOT RENEWED

Business

First Name

KATINA

Middle

DAWN

Last Name

WALLINE

Business Name

KATINA DAWN WALLINE

Original Issue Date

02/11/2004

Effective Date

01/04/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60622

County

COOK

Ever Disciplined

LastModifiedDate

12/28/2015