LIDIA S POMAVILLE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****74

License Status

ACTIVE

Business

First Name

LIDIA

Middle

Last Name

POMAVILLE

Business Name

LIDIA S POMAVILLE

Original Issue Date

03/22/2012

Effective Date

02/05/2026

Expiration Date

03/01/2028

City

BERWYN

State

Zip

60402

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2026