EILEEN THERESE REILLY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****94

License Status

NOT RENEWED

Business

First Name

EILEEN

Middle

THERESE

Last Name

REILLY

Business Name

EILEEN THERESE REILLY

Original Issue Date

11/13/2007

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/10/2011