LAUREN FORMELLA BROOKS DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151003

License Status

NOT RENEWED

Business

Title

First Name

LAUREN

Middle

FORMELLA

Last Name

BROOKS

Business Name

LAUREN FORMELLA BROOKS DO

Original Issue Date

10/11/2019

Effective Date

10/11/2019

Expiration Date

09/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

01/14/2021