TOWANDA SHANTA HARRIS-FULLER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045989

License Status

EXPIRED

Business

First Name

TOWANDA

Middle

SHANTA

Last Name

HARRIS-FULLER

Business Name

TOWANDA SHANTA HARRIS-FULLER

Original Issue Date

06/24/2003

Effective Date

06/24/2003

Expiration Date

06/23/2006

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006