SHALYN M VANDERBLOEMEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****73

License Status

NOT RENEWED

Business

First Name

SHALYN

Middle

Last Name

VANDERBLOEMEN

Business Name

SHALYN M VANDERBLOEMEN

Original Issue Date

02/01/2010

Effective Date

01/14/2020

Expiration Date

03/01/2022

City

MORTON GROVE

State

Zip

60053

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022