LAUREN FORMELLA BROOKS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070919

License Status

CANCELLED

Business

Title

First Name

LAUREN

Middle

FORMELLA

Last Name

BROOKS

Business Name

LAUREN FORMELLA BROOKS DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine and OMT

Ever Disciplined

LastModifiedDate

04/03/2017