ANNELIESE HEATHER MIZWICKI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****85

License Status

NOT RENEWED

Business

First Name

ANNELIESE

Middle

HEATHER

Last Name

MIZWICKI

Business Name

ANNELIESE HEATHER MIZWICKI

Original Issue Date

09/19/2013

Effective Date

02/06/2020

Expiration Date

03/01/2022

City

EVANSTON

State

Zip

60201

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022