JACQUELINE MARY BENNER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****87

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Middle

MARY

Last Name

BENNER

Business Name

JACQUELINE MARY BENNER

Original Issue Date

02/14/2008

Effective Date

01/05/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012