LISA KATHERINE FASONE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****61

License Status

ACTIVE

Business

First Name

LISA

Middle

KATHERINE

Last Name

FASONE

Business Name

LISA KATHERINE FASONE

Original Issue Date

10/31/2019

Effective Date

12/10/2025

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/10/2025