HEATHER LYNNE PROVENCHER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036135088

License Status

NOT RENEWED

Business

Title

First Name

HEATHER

Middle

LYNNE

Last Name

PROVENCHER

Business Name

HEATHER LYNNE PROVENCHER MD

Original Issue Date

04/22/2014

Effective Date

04/22/2014

Expiration Date

07/31/2017

City

SAN FRANCISCO

State

Zip

94117

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

11/01/2017