AUTUMN A JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****75

License Status

NOT RENEWED

Business

First Name

AUTUMN

Middle

Last Name

JACKSON

Business Name

AUTUMN A JACKSON

Original Issue Date

05/18/2007

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Ever Disciplined

LastModifiedDate

11/18/2010