ALIYAH J MANGRUM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****95

License Status

ACTIVE

Business

First Name

ALIYAH

Middle

Last Name

MANGRUM

Business Name

ALIYAH J MANGRUM

Original Issue Date

07/13/2023

Effective Date

01/19/2026

Expiration Date

03/01/2028

City

OAK LAWN

State

Zip

60453

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/19/2026