KIRSTYN HELEN GUSTAFSON Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059022

License Status

EXPIRED

Business

First Name

KIRSTYN

Middle

HELEN

Last Name

GUSTAFSON

Business Name

KIRSTYN HELEN GUSTAFSON

Original Issue Date

04/01/2011

Effective Date

04/01/2011

Expiration Date

03/31/2013

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

05/15/2013