ZOE ELLEN FORNBERG Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****69

License Status

ACTIVE

Business

First Name

ZOE

Middle

ELLEN

Last Name

FORNBERG

Business Name

ZOE ELLEN FORNBERG

Original Issue Date

08/07/2024

Effective Date

03/05/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60616

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/05/2026