KINZIE G BASHLINE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****82

License Status

INOPERATIVE

Business

First Name

KINZIE

Middle

Last Name

BASHLINE

Business Name

KINZIE G BASHLINE

Original Issue Date

09/14/2011

Effective Date

02/22/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

12/18/2019