MARY BERNADETTE WISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

MARY BERNADETTE

Last Name

WISE

Suffix

Business Name

MARY BERNADETTE WISE MD

Original Issue Date

01/01/1997

Effective Date

06/07/2017

Expiration Date

09/30/2020

City

PHOENIX

State

Zip

85018

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021