SABRINA M WAGNER Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047518

License Status

CANCELLED

Business

First Name

SABRINA

Middle

Last Name

WAGNER

Business Name

SABRINA M WAGNER

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2007

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006