NATASHA FOLDA O'GORMAN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****79

License Status

INOPERATIVE

Business

First Name

NATASHA

Middle

FOLDA

Last Name

O'GORMAN

Business Name

NATASHA FOLDA O'GORMAN

Original Issue Date

01/29/2008

Effective Date

02/14/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60608

County

COOK

Ever Disciplined

LastModifiedDate

07/13/2012