BROOKE KIMMERLE MADEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****91

License Status

NOT RENEWED

Business

First Name

BROOKE

Middle

KIMMERLE

Last Name

MADEN

Business Name

BROOKE KIMMERLE MADEN

Original Issue Date

09/21/2012

Effective Date

01/15/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

01/21/2016