HOLLY SUSANNE WILLMANN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****56

License Status

NOT RENEWED

Business

First Name

HOLLY

Middle

SUSANNE

Last Name

WILLMANN

Business Name

HOLLY SUSANNE WILLMANN

Original Issue Date

05/30/2002

Effective Date

05/30/2002

Expiration Date

03/01/2006

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006