RUSSELL AVELLANA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****82

License Status

NOT RENEWED

Business

First Name

RUSSELL

Last Name

AVELLANA

Business Name

RUSSELL AVELLANA

Original Issue Date

07/13/2019

Effective Date

02/01/2022

Expiration Date

03/01/2024

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025