MARY J PETRUSKA-NORDMANN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

PETRUSKA-NORDMANN

Business Name

MARY J PETRUSKA-NORDMANN

Original Issue Date

07/19/2001

Effective Date

07/19/2001

Expiration Date

07/31/2002

City

BELLEVILLE

State

Zip

62062

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006