PATRICIA E LACY 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

PATRICIA E

Last Name

LACY

Business Name

PATRICIA E LACY

Original Issue Date

06/25/2010

Effective Date

02/29/2012

Expiration Date

03/01/2014

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/08/2014