CARLY VORMEZEELE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****65

License Status

ACTIVE

Business

First Name

CARLY

Last Name

VORMEZEELE

Business Name

CARLY VORMEZEELE

Original Issue Date

07/01/2019

Effective Date

01/29/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/29/2026