ERICA MICHELLE FOVENESI Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****74

License Status

INOPERATIVE

Business

First Name

ERICA

Middle

MICHELLE

Last Name

FOVENESI

Business Name

ERICA MICHELLE FOVENESI

Original Issue Date

10/09/2014

Effective Date

10/09/2014

Expiration Date

03/01/2016

City

MORTON GROVE

State

Zip

60053

County

COOK

Ever Disciplined

LastModifiedDate

04/02/2015