KRISTINA RENEE ERICSSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057227

License Status

CANCELLED

Business

First Name

KRISTINA

Middle

RENEE

Last Name

ERICSSON

Suffix

Business Name

KRISTINA RENEE ERICSSON MD

Original Issue Date

07/08/2009

Effective Date

07/08/2009

Expiration Date

07/07/2011

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

06/24/2011