CARLY NICOLE LARSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****55

License Status

NOT RENEWED

Business

First Name

CARLY

Middle

NICOLE

Last Name

LARSON

Business Name

CARLY NICOLE LARSON

Original Issue Date

08/28/2013

Effective Date

01/27/2014

Expiration Date

03/01/2016

City

EVANSTON

State

Zip

60201

County

COOK

Ever Disciplined

LastModifiedDate

04/25/2016