ANDREA L BACA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****66

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

Last Name

BACA

Business Name

ANDREA L BACA

Original Issue Date

10/08/2003

Effective Date

10/08/2003

Expiration Date

03/01/2008

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

09/26/2006