JACQUELINE M CHAMPLAIN - Medical Doctor License in Illinois | # 125059551

JACQUELINE M CHAMPLAIN

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059551

License Status

CANCELLED

Business

N

First Name

JACQUELINE

Middle

M

Last Name

CHAMPLAIN

Business Name

JACQUELINE M CHAMPLAIN

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2014

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

05/25/2011