SALLY Y SA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****84

License Status

NOT RENEWED

Business

First Name

SALLY

Middle

Last Name

Business Name

SALLY Y SA

Original Issue Date

12/09/2008

Effective Date

03/01/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

04/16/2012