TERRA L GRYWALSKI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

NOT RENEWED

Business

First Name

TERRA

Middle

Last Name

GRYWALSKI

Business Name

TERRA L GRYWALSKI

Original Issue Date

07/30/2010

Effective Date

07/30/2010

Expiration Date

03/01/2012

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012