SHANNON L GULLINGSRUD Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****88

License Status

INOPERATIVE

Business

First Name

SHANNON

Middle

Last Name

GULLINGSRUD

Business Name

SHANNON L GULLINGSRUD

Original Issue Date

05/05/2014

Effective Date

02/08/2016

Expiration Date

03/01/2018

City

ELGIN

State

Zip

60120

County

KANE

Ever Disciplined

LastModifiedDate

05/02/2018