THERESE E SULLIVAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****95

License Status

NOT RENEWED

Business

First Name

THERESE

Middle

Last Name

SULLIVAN

Business Name

THERESE E SULLIVAN

Original Issue Date

11/13/2007

Effective Date

02/26/2016

Expiration Date

03/01/2018

City

CHICAGO

State

Zip

60622

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2018