HOLLY ELIZABETH VANNITAMBY DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071177

License Status

CANCELLED

Business

Title

First Name

HOLLY

Middle

ELIZABETH

Last Name

VANNITAMBY

Business Name

HOLLY ELIZABETH VANNITAMBY DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/01/2017