LISA A FOSNOT Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065627

License Status

EXPIRED

Business

First Name

LISA

Middle

Last Name

FOSNOT

Business Name

LISA A FOSNOT

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/19/2017