SHELLEY ROSE WAITE Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056149

License Status

CANCELLED

Business

First Name

SHELLEY

Middle

ROSE

Last Name

WAITE

Business Name

SHELLEY ROSE WAITE

Original Issue Date

06/22/2009

Effective Date

06/22/2009

Expiration Date

06/21/2012

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/04/2009