GRACE MARIE DANIELS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****96

License Status

NOT RENEWED

Business

First Name

GRACE

Middle

MARIE

Last Name

DANIELS

Business Name

GRACE MARIE DANIELS

Original Issue Date

08/19/2016

Effective Date

03/02/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60617

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020