STEPHANIE M DALLA RIVA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072740

License Status

CANCELLED

Business

Title

First Name

STEPHANIE

Middle

Last Name

DALLA RIVA

Business Name

STEPHANIE M DALLA RIVA MD

Original Issue Date

06/26/2021

Effective Date

06/26/2021

Expiration Date

06/25/2022

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Obstetrics and Gynecology

Ever Disciplined

LastModifiedDate

02/04/2021